Bergeat Damien, Rayar Michel, Mouchel Yann, Merdrignac Aude, Meunier Bernard, Lièvre Astrid, Boudjema Karim, Sulpice Laurent
Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.
Université de Rennes 1, Rennes, France.
Langenbecks Arch Surg. 2017 Feb;402(1):57-67. doi: 10.1007/s00423-017-1551-3. Epub 2017 Jan 13.
Bevacizumab associated with conventional chemotherapy has become standard care in the management of metastatic colorectal cancer. However, its impact on outcomes after liver resections (LRs) remains debated. The aim of this study was to evaluate the impact of neoadjuvant bevacizumab-based chemotherapy (BBC) on postoperative outcomes of LR for colorectal liver metastasis (CLM) using a validated approach.
All patients who received neoadjuvant therapy for CLMs between January 2005 and May 2011 were included. Risk factors for major complications (Clavien ≥3) were analyzed by univariate and multivariate analysis. Evaluation of BBC's impact on morbidity was conducted after a propensity score adjustment on factors identified to influence major complications (MCs).
LR for CLMs after neoadjuvant chemotherapy was performed in 199 patients (127 men and 72 women). Major LR was performed on 111 patients (55.78%), and MCs occurred in 41 cases (20.6%). After multivariate analyses, major LR (OR 2.85; 95% CI 1.29-6.85; P = 0.013) and combined resections of both the primary tumor and CLMs (OR 7.12; 95% CI: 2.6-20.5; P < 0.001) were independent predictive factors for MCs. After a propensity score matching, 56 patients with a BBC regimen were compared to 112 patients without BBC. No difference in terms of biliary fistula occurrence (P = 0.94) or 90-day mortality (P = 0.66) was found. Both in the univariate and multivariate analyses, BBC was not associated with MCs (P = 0.95).
The present study using propensity score matching demonstrated that BBC did not impair outcomes of LR for CLM.
贝伐单抗联合传统化疗已成为转移性结直肠癌治疗的标准方案。然而，其对肝切除术后结局的影响仍存在争议。本研究旨在采用经验证的方法评估基于贝伐单抗的新辅助化疗（BBC）对结直肠癌肝转移（CLM）肝切除术后结局的影响。
纳入2005年1月至2011年5月间接受CLM新辅助治疗的所有患者。通过单因素和多因素分析主要并发症（Clavien≥3级）的危险因素。在对确定影响主要并发症（MCs）的因素进行倾向评分调整后，评估BBC对发病率的影响。
199例患者（127例男性和72例女性）在新辅助化疗后接受了CLM肝切除术。111例患者（55.78%）进行了大肝切除术，41例（20.6%）发生了MCs。多因素分析后，大肝切除术（OR 2.85；95%CI 1.29 - 6.85；P = 0.013）和原发肿瘤与CLM联合切除术（OR 7.12；95%CI：2.6 - 20.5；P < 0.001）是MCs的独立预测因素。倾向评分匹配后，将56例接受BBC方案的患者与112例未接受BBC的患者进行比较。发现胆瘘发生率（P = 0.94）或90天死亡率（P = 0.66）无差异。在单因素和多因素分析中，BBC均与MCs无关（P = 0.95）。
本研究采用倾向评分匹配表明，BBC不会损害CLM肝切除术的结局。
