Imai Katsunori, Castro Benitez Carlos, Allard Marc-Antoine, Vibert Eric, Sa Cunha Antonio, Cherqui Daniel, Castaing Denis, Bismuth Henri, Baba Hideo, Adam René
Centre Hépato-Biliaire, AP-HP, Hôpital Universitaire Paul Brousse, Villejuif, France.
Inserm, Unité 935, Villejuif, France.
J Surg Oncol. 2017 Mar;115(4):488-496. doi: 10.1002/jso.24539. Epub 2017 Mar 31.
We aimed to define the cure rate in patients with colorectal liver metastases (CRLM) and concomitant extrahepatic disease (EHD) on the 5-year disease-free survival (DFS) after surgery, and identify the factors for predicting a cure.
Patients who underwent hepatectomy for CRLM with concomitant EHD were identified. Those followed for >5 years after surgery were enrolled. A cure was defined as DFS of >5 years after the last curative surgery.
A cure was achieved in 24/175 (13%) patients (intention-to-treat [ITT] cohort), and 22/109 (19%) patients who underwent complete resection for both hepatic and extrahepatic metastases (EHD resection cohort). A multivariate analysis identified primary T1-2 (relative risk [RR] 47.4, P = 0.0001), metachronous metastasis (RR 4.9, P = 0.026), carbohydrate antigen 19-9 (CA19-9) ≤37 U/mL (RR 8.37, P = 0.015), number of liver and EHD tumors (RR 11.2, P = 0.0058), and non-incidental EHD diagnosis (RR 8.41, P = 0.018) as independent factors that predicted a cure in the ITT cohort; and primary T1-2 (RR 22.2, P = 0.013), primary N0 (RR 4.42, P = 0.031), metachronous metastasis (RR 6.48, P = 0.013), and CA19-9 ≤37 U/mL (RR 27.4, P = 0.012) in the EHD resection cohort.
Even when concomitant EHD is present, a potential of cure could be achieved with aggressive oncosurgical approach.
我们旨在确定结直肠癌肝转移（CRLM）合并肝外疾病（EHD）患者术后5年无病生存（DFS）的治愈率，并确定预测治愈的因素。
确定接受CRLM合并EHD肝切除术的患者。纳入术后随访超过5年的患者。治愈定义为最后一次根治性手术后DFS超过5年。
在175例患者的意向性治疗（ITT）队列中，24例（13%）实现治愈；在109例肝转移和肝外转移均接受完全切除的患者（EHD切除队列）中，22例（19%）实现治愈。多因素分析确定，在ITT队列中，原发灶T1-2期（相对危险度[RR]47.4，P = 0.0001）、异时性转移（RR 4.9，P = 0.026）、糖类抗原19-9（CA19-9）≤37 U/mL（RR 8.37，P = 0.015）、肝和EHD肿瘤数量（RR 11.2，P = 0.0058）以及非偶然发现的EHD诊断（RR 8.41，P = 0.018）是预测治愈的独立因素；在EHD切除队列中，原发灶T1-2期（RR 22.2，P = 0.013）、原发灶N0期（RR 4.42，P = 0.031）、异时性转移（RR 6.48，P = 0.013）以及CA19-9≤37 U/mL（RR 27.4，P = 0.
