Leung Universe, Gönen Mithat, Allen Peter J, Kingham T Peter, DeMatteo Ronald P, Jarnagin William R, D'Angelica Michael I
*Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY †Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann Surg. 2017 Jan;265(1):158-165. doi: 10.1097/SLA.0000000000001624.
The aim of the study was to evaluate outcomes after resection of colorectal liver metastases (CRLM) and concurrent extrahepatic disease (EHD), and to define prognostic factors.
There is increasing evidence to support resection of liver metastases and concurrent EHD in selected patients. Long-term survival data are lacking, and prognostic factors are not well defined.
Retrospective review of 219 patients was undertaken between January 1992 and December 2012, who underwent hepatectomy for CRLM and resection of synchronous EHD. Survival outcomes were estimated by the Kaplan-Meier method. Univariate and multivariate analyses of prognostic factors were performed. A scoring system for prognostication was developed.
The median, 3, 5, and 10-year overall survival were 34.4 months, 49%, 28%, and 10%, respectively. Disease recurred in 185 patients (90.2%) at a median of 8 months. There were 8 actual 10-year survivors. The site of EHD affected survival, with portal, retroperitoneal nodes and multiple sites associated with the worst prognoses. The size of the largest CRLM, the number of CRLM, unfavorable site of EHD, and progression of CRLM on neoadjuvant therapy were associated with overall survival on univariate and multivariate analyses. Three variables, assigned 1 point each, were used to create an EHD risk score: largest CRLM greater than 3 cm, greater than 5 CRLM, and unfavorable site of EHD. The resulting score was prognostic of overall and recurrence-free survival.
Long-term survival is possible after resection of liver metastases and concurrent EHD, but true cure is rare. A proposed scoring system may identify patients most likely to benefit from surgery.
本研究旨在评估结直肠癌肝转移（CRLM）合并肝外疾病（EHD）切除术后的结局，并确定预后因素。
越来越多的证据支持对部分患者进行肝转移灶及合并的EHD切除术。目前缺乏长期生存数据，且预后因素尚不明确。
对1992年1月至2012年12月期间接受CRLM肝切除术及同期EHD切除术的219例患者进行回顾性分析。采用Kaplan-Meier法评估生存结局。对预后因素进行单因素和多因素分析。制定了一个预后评分系统。
中位、3年、5年和10年总生存率分别为34.4个月、49%、28%和10%。185例患者（90.2%）出现疾病复发，中位复发时间为8个月。有8例实际存活10年的患者。EHD的部位影响生存，门静脉、腹膜后淋巴结及多个部位的预后最差。单因素和多因素分析显示，最大CRLM的大小、CRLM的数量、EHD的不良部位以及新辅助治疗时CRLM的进展与总生存相关。三个变量各赋予1分，用于创建EHD风险评分：最大CRLM大于3 cm、CRLM大于5个以及EHD的不良部位。所得评分可预测总生存和无复发生存。
CRLM合并EHD切除术后有可能实现长期生存，但真正治愈的情况很少见。所提出的评分系统可能有助于识别最有可能从手术中获益的患者。
