Ayez N, van der Stok E P, Grünhagen D J, Rothbarth J, van Meerten E, Eggermont A M, Verhoef C
Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
Eur J Surg Oncol. 2015 Jul;41(7):859-67. doi: 10.1016/j.ejso.2015.04.012. Epub 2015 May 2.
The combination of surgery and chemotherapy (CTx) is increasingly accepted as an effective treatment for patients with colorectal liver metastases (CRLM). However, controversy exists whether all patients with resectable CRLM benefit from perioperative CTx. We investigated the impact on overall survival (OS) by neo-adjuvant CTx in patients with resectable CRLM, stratified by the clinical risk score (CRS) described by Fong et al.
Patients who underwent surgery for CRLM between January 2000 and December 2009 were included. We compared OS of patients with and without neo-adjuvant CTx stratified by the CRS. The CRS includes five prognosticators and defines two risk groups: low CRS (0-2) and high CRS (3-5).
363 patients (64% male) were included, median age 63 years (IQR 57-70). Prior to resection, 219 patients had a low CRS (neo-adjuvant CTx: N = 65) and 144 patients had a high CRS (neo-adjuvant CTx: N = 88). Median follow-up was 47 months (IQR 25-82). In the low CRS group, there was no significant difference in median OS between patients with and without CTx (65 months (95% CI 39-91) vs. 54 months (95% CI 44-64), P = 0.31). In the high CRS group, there was a significant difference in OS between patients with and without CTx (46 months (95% CI 24-68) vs. 33 month (95% CI 29-37), P = 0.004).
In our series, patients with a high CRS benefit from neo-adjuvant CTx. In patients with a low risk profile, neo-adjuvant CTx might not be beneficial.
手术与化疗（CTx）联合治疗越来越被认为是结直肠癌肝转移（CRLM）患者的有效治疗方法。然而，对于所有可切除的CRLM患者围手术期CTx是否有益存在争议。我们研究了新辅助CTx对可切除CRLM患者总生存期（OS）的影响，并根据Fong等人描述的临床风险评分（CRS）进行分层。
纳入2000年1月至2009年12月期间接受CRLM手术的患者。我们比较了接受和未接受新辅助CTx且按CRS分层的患者的OS。CRS包括五个预后因素，并定义了两个风险组：低CRS（0 - 2）和高CRS（3 - 5）。
共纳入363例患者（64%为男性），中位年龄63岁（四分位间距57 - 70岁）。切除术前，219例患者CRS低（新辅助CTx：N = 65），144例患者CRS高（新辅助CTx：N = 88）。中位随访时间为47个月（四分位间距25 - 82个月）。在低CRS组中，接受和未接受CTx的患者中位OS无显著差异（65个月（95%CI 39 - 91）对54个月（95%CI 44 - 64），P = 0.31）。在高CRS组中，接受和未接受CTx的患者OS存在显著差异（46个月（95%CI 24 - 68）对33个月（95%CI 29 - 37），P = 0.004）。
在我们的研究系列中，CRS高的患者从新辅助CTx中获益。在风险较低的患者中，新辅助CTx可能无益。
