Eefsen R L, Vermeulen P B, Christensen I J, Laerum O D, Mogensen M B, Rolff H C, Van den Eynden G G, Høyer-Hansen G, Osterlind K, Vainer B, Illemann M
The Finsen Laboratory, Rigshospitalet, Ole Maaleoes Vej 5, Building 3, 3rd Floor, 2200, Copenhagen, Denmark,
Clin Exp Metastasis. 2015 Apr;32(4):369-81. doi: 10.1007/s10585-015-9715-4. Epub 2015 Mar 31.
Despite improved therapy of advanced colorectal cancer, the median overall survival (OS) is still low. A surgical removal has significantly improved survival, if lesions are entirely removed. The purpose of this retrospective explorative study was to evaluate the prognostic value of histological growth patterns (GP) in chemonaive and patients receiving neo-adjuvant therapy. Two-hundred-fifty-four patients who underwent liver resection of colorectal liver metastases between 2007 and 2011 were included in the study. Clinicopathological data and information on neo-adjuvant treatment were retrieved from patient and pathology records. Histological GP were evaluated and related to recurrence free and OS. Kaplan-Meier curves, log-rank test and Cox regression analysis were used. The 5-year OS was 41.8% (95% CI 33.8-49.8%). Growth pattern evaluation of the largest liver metastasis was possible in 224 cases, with the following distribution: desmoplastic 63 patients (28.1%); pushing 77 patients (34.4%); replacement 28 patients (12.5%); mixed 56 patients (25.0%). The Kaplan-Meier analyses demonstrated that patients resected for liver metastases with desmoplastic growth pattern had a longer recurrence free survival (RFS) than patients resected for non-desmoplastic liver metastases (p=0.05). When patients were stratified according to neo-adjuvant treatment in the multivariate Cox regression model, hazard ratios for RFS compared to desmoplastic were: pushing (HR=1.37, 95% CI 0.93-2.02, p=0.116), replacement (HR=2.16, 95% CI 1.29-3.62, p=0.003) and mixed (HR=1.70, 95% CI 1.12-2.59, p=0.013). This was true for chemonaive patients as well as for patients who received neo-adjuvant treatment.
尽管晚期结直肠癌的治疗有所改善，但中位总生存期（OS）仍然较低。如果病变能够完全切除，手术切除可显著提高生存率。这项回顾性探索性研究的目的是评估组织学生长模式（GP）在未经化疗和接受新辅助治疗的患者中的预后价值。2007年至2011年间接受结直肠癌肝转移灶肝切除术的254例患者纳入本研究。从患者和病理记录中检索临床病理数据和新辅助治疗信息。评估组织学GP，并将其与无复发生存期和总生存期相关联。采用Kaplan-Meier曲线、对数秩检验和Cox回归分析。5年总生存率为41.8%（95%CI 33.8-49.8%）。224例患者的最大肝转移灶生长模式得以评估，分布如下：促纤维组织增生型63例（28.1%）；推挤型77例（34.4%）；替代型28例（12.5%）；混合型56例（25.0%）。Kaplan-Meier分析表明，因促纤维组织增生型生长模式的肝转移灶而接受手术切除的患者，其无复发生存期（RFS）比因非促纤维组织增生型肝转移灶而接受手术切除的患者更长（p=0.05）。在多变量Cox回归模型中，根据新辅助治疗对患者进行分层时，与促纤维组织增生型相比，RFS的风险比为：推挤型（HR=1.37，95%CI 0.93-2.02，p=0.116）、替代型（HR=2.16，95%CI 1.29-3.62，p=0.003）和混合型（HR=1.70，95%CI 1.12-2.59，p=0.013）。对于未经化疗的患者以及接受新辅助治疗的患者均是如此。
