Narita Masato, Oussoultzoglou Elie, Chenard Marie-Pierre, Fuchshuber Pascal, Yamamoto Tetsuro, Addeo Pietro, Jaeck Daniel, Bachellier Philippe
Centre de Chirurgie Viscérale et de Transplantation, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098, Strasbourg Cedex, France,
World J Surg. 2015 May;39(5):1167-76. doi: 10.1007/s00268-014-2916-1.
The aim of this case-control study was to identify clinicopathological factors and test three relevant biomarkers for their ability to predict early intrahepatic recurrence after curative liver resection for colorectal liver metastases (CLM).
Of the 184 patients with CLM undergoing hepatectomy between January 2007 and December 2009, thirty patients had intrahepatic disease recurrence within 6 months. The control group was randomly selected from a cohort of patients between April 1997 and December 2005 who have survived without disease recurrence after CLM resection for over 5 years. Both groups were matched for size of metastasis greater than 5.0 cm, the presence of multiple metastases, and synchronous versus metachronous CLM. The final study population consisted of 60 patients with CLM undergoing R0 hepatectomy, 30 of whom had early intrahepatic-only recurrences (study group) and 30 patients without recurrence for more than 5 years (control group). Both groups were analyzed and compared for the presence of clinical factors and expression levels of CD133, survivin, and Bcl-2 within tumor tissue.
Characteristics of patients were similar between the two groups except primary tumor location and administration of postoperative chemotherapy. Expression level of CD133 and survivin were significantly increased in tumors of patients with recurrence compared to patients without recurrence. On multivariate analysis high tumor expression levels of CD133 (odds ratio [OR] 14.7, confidence interval [CI] 1.8-121.3, p = 0.012) and survivin (OR 9.5, CI 2.1-44.3, p = 0.004) and postoperative chemotherapy (OR 4.8, CI 1.01-22.9, p = 0.049) were independent factors associated with early intrahepatic recurrence.
Tumor expression levels of CD133 and survivin may be a useful predictor of early intrahepatic recurrence after hepatectomy for CLM. Administration of postoperative chemotherapy may prevent early intrahepatic recurrence.
本病例对照研究的目的是确定临床病理因素，并检测三种相关生物标志物预测结直肠癌肝转移（CLM）根治性肝切除术后早期肝内复发的能力。
在2007年1月至2009年12月期间接受肝切除术的184例CLM患者中，30例在6个月内出现肝内疾病复发。对照组从1997年4月至2005年12月期间CLM切除术后无疾病复发存活超过5年的患者队列中随机选取。两组在转移灶大小大于5.0 cm、存在多发转移以及同时性与异时性CLM方面进行匹配。最终研究人群包括60例接受R0肝切除术的CLM患者，其中30例有仅早期肝内复发（研究组），30例无复发超过5年（对照组）。对两组的临床因素存在情况以及肿瘤组织中CD133、生存素和Bcl-2的表达水平进行分析和比较。
除原发肿瘤位置和术后化疗外，两组患者特征相似。与无复发患者相比，复发患者肿瘤中CD133和生存素的表达水平显著升高。多因素分析显示，肿瘤中CD133高表达水平（比值比[OR] 14.7，置信区间[CI] 1.8 - 121.3，p = 0.012）、生存素高表达水平（OR 9.5，CI 2.1 - 44.3，p = 0.004）以及术后化疗（OR 4.8，CI 1.01 - 22.9，p = 0.049）是与早期肝内复发相关的独立因素。
CD133和生存素的肿瘤表达水平可能是CLM肝切除术后早期肝内复发的有用预测指标。术后化疗可能预防早期肝内复发。
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