Strowitzki Moritz J, Schmidt Thomas, Keppler Ulrich, Ritter Alina S, Mahmoud Sarah, Klose Johannes, Mihaljevic André L, Schneider Martin, Büchler Markus W, Ulrich Alexis B
Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
J Surg Oncol. 2017 Aug;116(2):149-158. doi: 10.1002/jso.24631. Epub 2017 Apr 13.
There is ongoing debate about whether patients planned for liver resection of colorectal liver metastases (CRLM) benefit from neoadjuvant chemotherapy (NC). Therefore, we performed a retrospective survival analysis of patients with and without NC prior to surgery.
Data prospectively collected from 468 consecutive patients were analyzed in a retrospective design. We performed a survival analysis and added propensity score matching (PSM). Univariate and multivariate analysis was performed to determine independent prognostic risk factors.
NC was performed in 145/468 patients. NC did not have a significant influence on overall survival (OS) either before or after PSM. Patients receiving NC showed increased complication rates, especially concerning non-surgical complications after primary resection (P = 0.025) of CRLM. Multivariate analysis before and after PSM revealed that the Memorial Sloan Kettering Cancer Center (MSKCC) score and CEA values are strong predictors for OS in patients with CRLM.
NC was not associated with increased OS in patients suffering from CRLM. Additionally, potentially harmful chemotherapy prior to surgery increases the risk of postoperative complications in these patients.
对于计划进行结直肠癌肝转移（CRLM）肝切除的患者是否能从新辅助化疗（NC）中获益，目前仍存在争议。因此，我们对术前接受和未接受NC的患者进行了回顾性生存分析。
采用回顾性设计分析前瞻性收集的468例连续患者的数据。我们进行了生存分析并增加了倾向评分匹配（PSM）。进行单因素和多因素分析以确定独立的预后危险因素。
468例患者中有145例接受了NC。NC对PSM前后的总生存期（OS）均无显著影响。接受NC的患者并发症发生率增加，尤其是CRLM初次切除术后的非手术并发症（P = 0.025）。PSM前后的多因素分析显示，纪念斯隆凯特琳癌症中心（MSKCC）评分和癌胚抗原（CEA）值是CRLM患者OS的强预测指标。
NC与CRLM患者的OS增加无关。此外，术前潜在有害的化疗会增加这些患者术后并发症的风险。
