Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hepatobiliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Ann Surg Oncol. 2017 Aug;24(8):2326-2333. doi: 10.1245/s10434-017-5845-z. Epub 2017 Mar 27.
A potentially favorable effect of chemotherapy on the incidence of micrometastases has been reported in patients with colorectal liver metastases (CLMs); however, the actual influence of chemotherapy on the distribution of micrometastases and surgical curability remains unclear.
The clinical impact of preoperative chemotherapy on the incidence and distribution of micrometastases was assessed in 191 patients with 357 CLM nodules. Potential radiologic measures for predicting the extent of microscopic cancer spread and surgical curability were then sought among the size-based and non-size-based radiologic response criteria.
Multivariate analysis estimated a reduced incidence of micrometastases in patients receiving preoperative chemotherapy (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26-0.76, p = 0.003). Furthermore, the addition of biologic agents to the preoperative chemotherapy regimen was correlated with a reduced incidence of microscopic cancer spread beyond a width of 1 mm from the margin of the main tumor (OR 0.28, 95% CI 0.11-0.74, p = 0.010 for bevacizumab; and OR 0.29, 95% CI 0.09-0.99, p = 0.048 for anti-epidermal growth factor receptor antibody). Receiver operating characteristic analyses revealed that the computed tomography (CT) morphologic response showed a moderate predictive power for the distribution of micrometastases, with an area under the curve of 0.687, while size-based response criteria were not reliable for estimating the extent of microscopic cancer spread.
Notwithstanding the potential selection of patients after preoperative chemotherapy, the incidence and distribution of micrometastases may be reduced by preoperative chemotherapy. CT morphologic response may be a reliable predictor of both the degree of microscopic cancer spread and the curability of surgery.
有报道称，化疗可能对结直肠癌肝转移（CLM）患者的微转移发生率产生有利影响；然而，化疗对微转移分布和手术可切除性的实际影响仍不清楚。
本研究评估了 191 例 357 个 CLM 结节患者的术前化疗对微转移发生率和分布的临床影响。然后，在基于大小和非大小的放射学反应标准中，寻找预测微观癌症扩散程度和手术可切除性的潜在放射学测量指标。
多变量分析估计术前化疗患者微转移发生率降低（比值比 [OR] 0.45，95%置信区间 [CI] 0.26-0.76，p=0.003）。此外，在术前化疗方案中添加生物制剂与主肿瘤边缘 1mm 以外的显微镜下癌症扩散发生率降低相关（贝伐珠单抗 OR 0.28，95%CI 0.11-0.74，p=0.010；抗表皮生长因子受体抗体 OR 0.29，95%CI 0.09-0.99，p=0.048）。受试者工作特征分析显示，CT 形态学反应对微转移分布具有中等预测能力，曲线下面积为 0.687，而基于大小的反应标准无法可靠地估计微观癌症扩散程度。
尽管术前化疗后存在患者选择的潜在情况，但术前化疗可能会降低微转移的发生率和分布。CT 形态学反应可能是预测微观癌症扩散程度和手术可切除性的可靠指标。
