Adam René, Yi Bin, Innominato Pasquale F, Barroso Eduardo, Laurent Christophe, Giuliante Felice, Capussotti Lorenzo, Lapointe Réal, Regimbeau Jean-Marc, Lopez-Ben Santiago, Isoniemi Helena, Hubert Catherine, Lin Jen-Kou, Gruenberger Thomas, Elias Dominique, Skipenko Oleg G, Guglielmi Alfredo
Hepatobiliary Center, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Inserm U935, Villejuif, France.
Hepatobiliary Center, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Inserm U935, Villejuif, France; Eastern Hepatobiliary Surgery Hospital/National Liver Cancer Center, Second Military Medical University, Shanghai, China.
Eur J Cancer. 2017 Jun;78:7-15. doi: 10.1016/j.ejca.2017.03.009. Epub 2017 Apr 10.
Patient outcome after resection of colorectal liver metastases (CLM) following second-line preoperative chemotherapy (PCT) performed for insufficient response or toxicity of the first-line, is little known and has here been compared to the outcome following first-line.
From January 2005 to June 2013, 5624 and 791 consecutive patients of a prospective international cohort received 1 and 2 PCT lines before CLM resection (group 1 and 2, respectively). Survival and prognostic factors were analysed.
After a mean follow-up of 30.1 months, there was no difference in survival from CLM diagnosis (median, 3-, and 5-year overall survival [OS]: 58.6 months, 76% and 49% in group 2 versus 58.9 months, 71% and 49% in group 1, respectively, P = 0.32). After hepatectomy, disease-free survival (DFS) was however shorter in group 2: 17.2 months, 27% and 15% versus 19.4 months, 32% and 23%, respectively (P = 0.001). Among the initially unresectable patients of group 1 and 2, no statistical difference in OS or DFS was observed. Independent predictors of worse OS in group 2 were positive primary lymph nodes, extrahepatic disease, tumour progression on second line, R2 resection and number of hepatectomies/year <50. Positive primary nodes, synchronous and bilateral metastases were predictors of shorter DFS. Initial unresectability did not impact OS or DFS in group 2.
CLM resection following second-line PCT, after oncosurgically favourable selection, could bring similar OS compared to what observed after first-line. For initially unresectable patients, OS or DFS is comparable between first- and second-line PCT. Surgery should not be denied after the failure of first-line chemotherapy.
对于一线术前化疗（PCT）因反应不足或毒性而进行二线PCT后切除结直肠癌肝转移灶（CLM）的患者结局，人们了解甚少，本文将其与一线PCT后的结局进行了比较。
2005年1月至2013年6月，一个前瞻性国际队列中的5624例和791例连续患者在CLM切除术前分别接受了1线和2线PCT（分别为第1组和第2组）。分析了生存情况和预后因素。
平均随访30.1个月后，从CLM诊断开始的生存率无差异（中位数、3年和5年总生存率[OS]：第2组分别为58.6个月、76%和49%，第1组分别为58.9个月、71%和49%，P = 0.32）。然而，肝切除术后，第2组的无病生存期（DFS）较短：分别为17.2个月、27%和15%，而第1组分别为19.4个月、32%和23%（P = 0.001）。在第1组和第2组最初不可切除的患者中，未观察到OS或DFS的统计学差异。第2组中OS较差的独立预测因素为原发淋巴结阳性、肝外疾病、二线肿瘤进展、R2切除以及每年肝切除例数<50。原发淋巴结阳性、同时性和双侧转移是DFS较短的预测因素。初始不可切除对第2组的OS或DFS无影响。
经过肿瘤外科有利选择后，二线PCT后切除CLM可带来与一线PCT后相似的OS。对于最初不可切除的患者，一线和二线PCT的OS或DFS相当。一线化疗失败后不应拒绝手术。
