Beamish Paul, Lemke Madeline, Li Jennifer, Dixon Elijah, Abraham Mauro T, Hernandez-Alejandro Roberto, Bennett Sean, Martel Guillaume, Karanicolas Paul J
Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
HPB (Oxford). 2017 Aug;19(8):675-681. doi: 10.1016/j.hpb.2017.03.010. Epub 2017 May 8.
Recent advances in care for colorectal liver metastases (CRLM) have lengthened 5-year survival. In this new era, prognostic tools such as the clinical risk score (CRS) for colorectal liver metastases require reevaluation.
Patients undergoing resection for CRLM between 2008 and 2012 at 4 specialty hepatobiliary centers in Canada (N = 740) were stratified by CRS and analyzed in Kaplan-Meier survival curves. Primary outcome of overall survival (OS) and secondary outcome of recurrence-free survival (RFS). Multivariate Cox regression compared CRS to patient factors.
Median OS not reached (>60 months), median RFS 16 months. Original CRS strata was a significant (p < 0.001) predictor of both OS (5-year OS: 0; 75%, 1; 71%, 2; 57%, 3; 57%, 4; 46%) and RFS (5-year RFS: 0; 39%, 1; 33%, 2; 21%, 3; 21%, 4; 8%). The presence of extrahepatic colorectal metastatic disease increased recurrence risk (RFS hazard ratio of 1.32 (1.06-1.65)), and the use of intraoperative portal pedicle clamping reduced recurrence risk (RFS hazard ratio of 0.78 (0.61-0.99)).
The CRS remains a relevant tool for predicting long-term outcomes for patients undergoing resection of CRLM. Additional factors such as the presence of extrahepatic colorectal metastatic disease and the use of intraoperative portal pedicle clamping may improve the prognostic power of the CRS.
结直肠癌肝转移（CRLM）治疗的最新进展延长了患者的5年生存率。在这个新时代，结直肠癌肝转移的临床风险评分（CRS）等预后工具需要重新评估。
2008年至2012年期间，在加拿大4个专业肝胆中心接受CRLM切除术的患者（N = 740）按CRS分层，并通过Kaplan-Meier生存曲线进行分析。主要结局为总生存期（OS），次要结局为无复发生存期（RFS）。多变量Cox回归将CRS与患者因素进行比较。
中位总生存期未达到（>60个月），中位无复发生存期为16个月。原始CRS分层是总生存期（5年总生存期：0；75%，1；71%，2；57%，3；57%，4；46%）和无复发生存期（5年无复发生存期：0；39%，1；33%，2；21%，3；21%，4；8%）的显著（p < 0.001）预测指标。肝外结直肠癌转移疾病的存在增加了复发风险（无复发生存期风险比为1.32（1.06 - 1.65）），术中门静脉蒂阻断的使用降低了复发风险（无复发生存期风险比为0.78（0.61 - 0.99））。
CRS仍然是预测接受CRLM切除术患者长期预后的相关工具。肝外结直肠癌转移疾病的存在和术中门静脉蒂阻断的使用等其他因素可能会提高CRS的预后预测能力。
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