Kawamura Junichiro, Yazawa Takefumi, Sumida Kimiaki, Kida Yuya, Ogawa Ryotaro, Tani Masaki, Kawasoe Junya, Yamamoto Michihiro, Harada Hideki, Yamamoto Hidekazu, Zaima Masazumi
Department of Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan.
Department of Surgery, Faculty of Medicine, Kinki University, 377-2 Ohno Higashi, Osaka, Sayama, Osaka, 589-8511, Japan.
World J Surg Oncol. 2016 Feb 25;14:56. doi: 10.1186/s12957-016-0807-7.
This study sought to clarify the clinical benefits of liver resection after downsizing systemic chemotherapy for initially unresectable colorectal liver metastases (CLM).
Survival and clinical characteristics of CLM patients who underwent resection between January 2001 and December 2013 were retrospectively assessed. The study cohort of 88 patients with limited liver disease who underwent curative liver resection comprised 34 with initially resectable synchronous disease (synchronous group), 38 with initially resectable metachronous disease (metachronous group), and 16 with initially unresectable converted disease (conversion group).
The median duration of follow-up for the overall study population was 33 (1-98) months. Overall survival (OS) in the conversion group was not significantly different from that in the other groups. However, disease-free survival (DFS) in the conversion group was significantly shorter than that in the synchronous group. The median DFS was 19.1 months in the synchronous group, 16.6 months in the metachronous group, and 15.3 months in the conversion group. Most patients in the conversion group had recurrence shortly after liver resection in the remnant liver with or without metastases at other sites, but many could undergo repeat hepatectomy or resection of the metastases at other sites.
Although the converted patients tended to have recurrence shortly after liver resection, survival could be prolonged by repeat hepatectomy or resection of metastases at other sites. Liver resection after downsizing chemotherapy appears to be efficacious for patients with initially unresectable CLM and may result in long-term outcomes equivalent to those of patients with initially resectable CLM.
本研究旨在阐明对于初始不可切除的结直肠癌肝转移（CLM）患者，在进行缩小肿瘤体积的全身化疗后行肝切除术的临床益处。
回顾性评估2001年1月至2013年12月期间接受肝切除术的CLM患者的生存情况和临床特征。研究队列包括88例局限性肝脏疾病且接受根治性肝切除术的患者，其中34例为初始可切除的同时性疾病（同时性组），38例为初始可切除的异时性疾病（异时性组），16例为初始不可切除但转为可切除的疾病（转化组）。
整个研究人群的中位随访时间为33（1 - 98）个月。转化组的总生存期（OS）与其他组无显著差异。然而，转化组的无病生存期（DFS）显著短于同时性组。同时性组的中位DFS为19.1个月，异时性组为16.6个月，转化组为15.3个月。转化组的大多数患者在肝切除术后不久，在残余肝脏出现复发，有或无其他部位转移，但许多患者可接受再次肝切除术或其他部位转移灶切除术。
尽管转化患者在肝切除术后不久往往会复发，但通过再次肝切除术或其他部位转移灶切除术可延长生存期。对于初始不可切除的CLM患者，缩小肿瘤体积化疗后行肝切除术似乎有效，且可能产生与初始可切除的CLM患者相当的长期预后。
