Parkin E, O'Reilly D A, Adam R, Kaiser G M, Laurent C, Elias D, Capussotti L, Renehan A G
Institute of Cancer Sciences, University of Manchester, Manchester, UK; Department of Hepatobiliary Surgery, North Manchester General Hospital, Manchester, UK.
Institute of Cancer Sciences, University of Manchester, Manchester, UK; Department of Hepatobiliary Surgery, North Manchester General Hospital, Manchester, UK.
Eur J Surg Oncol. 2014 Nov;40(11):1436-44. doi: 10.1016/j.ejso.2014.07.040. Epub 2014 Aug 21.
We previously reported that the presence of steatosis did not adversely influence survival in patients undergoing resection for colorectal liver metastases (CLM) without pre-operative chemotherapy. Here, this hypothesis is tested in patients undergoing resection for CLM following pre-operative chemotherapy.
We assessed the effects of background liver pathology, categorized as 'normal', 'steatosis' and 'other', on perioperative mortality, overall survival (OS) and cancer-specific survival (CSS) in LiverMetSurvey patients. Survival analyses included log-rank tests and multivariate Cox models, incorporating well-established prognosticators. In secondary analyses, re-populating the model with non-chemotherapy patients, the effect modification of chemotherapy on the impact of steatosis on survival was tested.
Of 4329 patients undergoing first-time liver resection following pre-operative chemotherapy, histologies were normal in 1913 (44%), steatosis in 1675 (39%), and other abnormal pathologies in 741 (17%). For normal, steatosis and other, 90-day mortalities were 2.1%, 2.3%, and 3.5% (P = 0.103). For the three histo-pathological groups, 5-year OS rates were 39%, 42%, and 36% (Plogrank = 0.363); 5-year CSS rates were 43%, 45% and 41% (Plogrank = 0.496), respectively. The associations of steatosis with OS and CSS were materially unchanged in the multivariate models. Chemotherapy did not interact with the effect of steatosis on survival.
The findings of equivalent survivals challenge the common perception that steatosis in CLM patients after pre-operative chemotherapy is associated with increased peri-operative mortality and poorer long-term survival.
我们之前报道过，在未接受术前化疗而行结直肠癌肝转移（CLM）切除术的患者中，脂肪变性的存在对生存率没有不利影响。在此，该假设在接受术前化疗后行CLM切除术的患者中进行检验。
我们评估了LiverMetSurvey患者中背景肝脏病理（分为“正常”、“脂肪变性”和“其他”）对围手术期死亡率、总生存期（OS）和癌症特异性生存期（CSS）的影响。生存分析包括对数秩检验和多变量Cox模型，并纳入了公认的预后因素。在二次分析中，用未接受化疗的患者重新构建模型，检验化疗对脂肪变性对生存影响的效应修正。
在4329例接受术前化疗后首次肝切除术的患者中，1913例（44%）组织学正常，1675例（39%）有脂肪变性，741例（17%）有其他异常病理。正常、脂肪变性和其他组的90天死亡率分别为2.1%、2.3%和3.5%（P = 0.103）。对于这三个组织病理学组，5年OS率分别为39%、42%和36%（对数秩P = 0.363）；5年CSS率分别为43%、45%和41%（对数秩P = 0.496）。在多变量模型中，脂肪变性与OS和CSS的关联基本未变。化疗与脂肪变性对生存的影响没有相互作用。
生存率相当的研究结果挑战了一种普遍观念，即术前化疗后CLM患者的脂肪变性与围手术期死亡率增加和长期生存率较差有关。
