贝伐珠单抗治疗后结直肠癌肝转移行肝切除时切缘状态的预后影响。

Prognostic impact of margin status in liver resections for colorectal metastases after bevacizumab.

机构信息

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

出版信息

Br J Surg. 2017 Jun;104(7):926-935. doi: 10.1002/bjs.10510. Epub 2017 Mar 7.

DOI:10.1002/bjs.10510

PMID:28266705

Abstract

BACKGROUND

Margin status with resection of colorectal liver metastasis (CRLM) was an important prognostic factor in the years before the introduction of biological chemotherapy. This study examined outcomes following CRLM resection in patients who received neoadjuvant chemotherapy with or without the monoclonal antiangiogenic antibody bevacizumab.

METHODS

Patients who underwent surgery for CRLM at the Johns Hopkins Hospital between 2000 and 2015 were identified from an institutional database. Data regarding surgical margin status, preoperative bevacizumab administration and overall survival (OS) were assessed using multivariable analyses.

RESULTS

Of 630 patients who underwent CRLM resection, 417 (66·2 per cent) received neoadjuvant chemotherapy with (214, 34·0 per cent) or without (203, 32·2 per cent) bevacizumab. The remaining 213 (33·8 per cent) did not receive neoadjuvant chemotherapy. Univariable analysis found that positive margins were associated with worse 5-year OS than R0 resection (36·2 versus 54·9 per cent; P = 0·005). After dichotomizing by the receipt of preoperative bevacizumab versus chemotherapy alone, the prognostic value of pathological margin persisted among patients who did not receive preoperative bevacizumab (5-year OS 53·0 versus 37 per cent after R0 versus R1 resection; P = 0·010). OS was not significantly associated with margin status in bevacizumab-treated patients (5-year OS 46·8 versus 33 per cent after R0 versus R1 resection; P = 0·081), in whom 5-year survival was slightly worse (presumably reflecting more advanced disease) than among patients treated with cytotoxic agents alone. Pathological margin status was not significantly associated with 5-year OS in patients with a complete or near-complete response to chemotherapy and bevacizumab (43 versus 30 per cent after R0 versus R1 resection; P = 0·917), but this may be due to a type II error.

CONCLUSION

The impact of margin status varied according to the receipt of bevacizumab. Bevacizumab may have a role to play in improving outcomes among patients with more advanced disease.

摘要

背景

结直肠肝转移（CRLM）切除术后的切缘状态是引入生物化疗前的一个重要预后因素。本研究检测了接受新辅助化疗联合或不联合单克隆抗血管生成抗体贝伐珠单抗的 CRLM 切除术后患者的结局。

方法

从机构数据库中确定了 2000 年至 2015 年在约翰霍普金斯医院接受 CRLM 切除术的患者。使用多变量分析评估手术切缘状态、术前贝伐珠单抗使用和总生存期（OS）的数据。

结果

在 630 例接受 CRLM 切除术的患者中，417 例（66.2%）接受了新辅助化疗（214 例，34.0%）或无贝伐珠单抗（203 例，32.2%）。其余 213 例（33.8%）未接受新辅助化疗。单变量分析发现，阳性切缘与 5 年 OS 差于 RO 切除相关（36.2%比 54.9%；P=0.005）。在根据接受术前贝伐珠单抗与单独化疗进行二分类后，在未接受术前贝伐珠单抗的患者中，病理切缘的预后价值仍然存在（RO 与 R1 切除后 5 年 OS 为 53.0%比 37%；P=0.010）。在接受贝伐珠单抗治疗的患者中，边缘状态与 OS 无显著相关性（RO 与 R1 切除后 5 年 OS 为 46.8%比 33%；P=0.081），其 5 年生存率略差（可能反映了更晚期的疾病）比单独接受细胞毒性药物治疗的患者。在对化疗和贝伐珠单抗完全或接近完全缓解的患者中，病理切缘状态与 5 年 OS 无显著相关性（RO 与 R1 切除后 43%比 30%；P=0.917），但这可能是由于二类错误。