Nishioka Yujiro, Shindoh Junichi, Yoshioka Ryuji, Gonoi Wataru, Abe Hiroyuki, Okura Naoki, Yoshida Shuntaro, Oba Masaru, Hashimoto Masaji, Watanabe Goro, Hasegawa Kiyoshi, Kokudo Norihiro
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Gastrointest Surg. 2015 Sep;19(9):1653-61. doi: 10.1007/s11605-015-2836-x. Epub 2015 Apr 28.
The computed tomography (CT) morphology after chemotherapy is reportedly correlated with the histopathologic response to chemotherapy and a better surgical outcome in patients with colorectal liver metastases (CLM). However, the true prognostic advantage of CT morphology remains uncertain.
The prognostic advantage of CT morphology was validated in 86 patients who underwent surgical resection for CLM after undergoing a 5-fluorouracil-based chemotherapy regimen with or without bevacizumab.
An optimal morphologic response was observed in 18 (22.8%) patients, and a strong correlation between the CT morphology and tumor viability was confirmed (P < 0.001). A multivariate analysis revealed that bevacizumab (odds ratio [OR], 6.8; P = 0.03) and chemotherapy cycles ≥6 (OR, 3.6; P = 0.04) were associated with an optimal morphologic response. Overall survival (OS) and recurrence-free survival (RFS) were also predicted by CT morphology with a higher sensitivity. Particularly, a group 1 morphology was associated with a higher OS rate (3-year OS 100%) and RFS rate (3-year RFS, 57.0%), and a multivariate analysis confirmed that group 2 and group 3 tumor morphology was a significant predictive factor for tumor recurrence (hazard ratio [HR], 2.5; P = 0.03 and HR, 3.2; P < 0.01, respectively).
The CT morphology of CLM predicts tumor viability and long-term surgical outcomes after chemotherapy.
据报道，化疗后的计算机断层扫描（CT）形态与结直肠癌肝转移（CLM）患者对化疗的组织病理学反应及更好的手术结果相关。然而，CT形态真正的预后优势仍不确定。
对86例接受含或不含贝伐单抗的基于5-氟尿嘧啶化疗方案后接受CLM手术切除的患者，验证CT形态的预后优势。
18例（22.8%）患者观察到最佳形态学反应，且证实CT形态与肿瘤活性之间存在强相关性（P < 0.001）。多变量分析显示，贝伐单抗（比值比[OR]，6.8；P = 0.03）和化疗周期≥6（OR，3.6；P = 0.04）与最佳形态学反应相关。CT形态学对总生存期（OS）和无复发生存期（RFS）也有较高敏感性的预测作用。特别是，1组形态与较高的OS率（3年OS为100%）和RFS率（3年RFS为57.0%）相关，多变量分析证实2组和3组肿瘤形态是肿瘤复发的显著预测因素（风险比[HR]，2.5；P = 0.03和HR，3.2；P < 0.01）。
CLM的CT形态可预测化疗后肿瘤活性及长期手术结果。
