Nozawa Hiroaki, Ishihara Soichiro, Kawai Kazushige, Hata Keisuke, Kiyomatsu Tomomichi, Tanaka Toshiaki, Nishikawa Takeshi, Otani Kensuke, Yasuda Koji, Sasaki Kazuhito, Murono Koji, Nakajima Jun, Watanabe Toshiaki
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Oncology. 2017;92(3):135-141. doi: 10.1159/000453335. Epub 2017 Jan 5.
Clinical trials demonstrated that 6-37% of the patients with colorectal liver-limited metastases underwent surgical resection after first-line chemotherapy. However, limited information is available on the conversion of colorectal cancer patients with lung metastases to resection by systemic chemotherapy.
We retrospectively investigated 156 patients with unresectable colorectal cancer who received oxaliplatin- or irinotecan-based first-line systemic chemotherapy with or without antibodies in our department between January 2007 and December 2015. The conversion rate to surgery and chemotherapeutic regimens and periods were analyzed with respect to the target organ.
In addition to 4 patients who achieved complete response, 73 exhibited tumor shrinkage of any extent. Twenty patients underwent secondary surgery, all of whom received targeting antibodies. In 75 patients with liver metastases, 18 (24%) were converted to resection after chemotherapy for a median of 110 days. In contrast, 4 (7%) out of 56 patients with lung metastases underwent resection after chemotherapy for a median of 449 days. Conversion was an independent prognostic factor in patients with lung metastases.
The conversion rate to resection was lower for colorectal cancer patients with lung metastasis by systemic chemotherapy, which required a longer duration than for those with liver metastases.
临床试验表明，6%至37%的结直肠癌肝局限性转移患者在一线化疗后接受了手术切除。然而，关于经全身化疗将伴有肺转移的结直肠癌患者转化为可切除状态的信息有限。
我们回顾性研究了2007年1月至2015年12月期间在我科接受以奥沙利铂或伊立替康为基础的一线全身化疗（加或不加抗体）的156例不可切除的结直肠癌患者。分析了手术转化率、化疗方案及疗程与靶器官的关系。
除4例达到完全缓解的患者外，73例患者出现了不同程度的肿瘤缩小。20例患者接受了二次手术，所有患者均接受了靶向抗体治疗。在75例肝转移患者中，18例（24%）在化疗后中位110天转化为可切除状态。相比之下，56例肺转移患者中有4例（7%）在化疗后中位449天接受了手术切除。转化是肺转移患者的独立预后因素。
经全身化疗，伴有肺转移的结直肠癌患者的手术转化率较低，且所需时间比肝转移患者更长。
