Division of Surgery and Urology, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
Oncologist. 2017 Sep;22(9):1067-1074. doi: 10.1634/theoncologist.2017-0028. Epub 2017 May 26.
Assessing patients with colorectal cancer liver metastases (CRCLM) by a liver multidisciplinary team (MDT) results in higher resection rates and improved survival. The aim of this study was to evaluate the potentially improved resection rate in a defined cohort if all patients with CRCLM were evaluated by a liver MDT.
A retrospective analysis of patients diagnosed with colorectal cancer during 2008 in the greater Stockholm region was conducted. All patients with liver metastases (LM), detected during 5-year follow-up, were re-evaluated at a fictive liver MDT in which previous imaging studies, tumor characteristics, medical history, and patients' own treatment preferences were presented. Treatment decisions for each patient were compared to the original management. Odds ratios (ORs) and 95% confidence intervals were estimated for factors associated with referral to the liver MDT.
Of 272 patients diagnosed with LM, 102 patients were discussed at an original liver MDT and 69 patients were eventually resected. At the fictive liver MDT, a further 22 patients were considered as resectable/potentially resectable, none previously assessed by a hepatobiliary surgeon. Factors influencing referral to liver MDT were age (OR 3.12, 1.72-5.65), American Society of Anaesthesiologists (ASA) score (OR 0.34, 0.18-0.63; ASA 2 vs. ASA 3), and number of LM (OR 0.10, 0.04-0.22; 1-5 LM vs. >10 LM), while gender ( = .194) and treatment at a teaching hospital ( = .838) were not.
A meaningful number of patients with liver metastases are not managed according to best available evidence and the potential for higher resection rates is substantial.
Patients with liver metastatic colorectal cancer who are assessed at a hepatobiliary multidisciplinary meeting achieve higher resection rates and improved survival. Unfortunately, patients who may benefit from resection are not always properly referred. In this study, the potential improved resection rate was assessed by re-evaluating all patients with liver metastases from a population-based cohort, including patients with extrahepatic metastases and accounting for comorbidity and patients' own preferences towards treatment. An additional 12.9% of the patients were found to be potentially resectable. The results highlight the importance of all patients being evaluated in the setting of a hepatobiliary multidisciplinary meeting.
通过肝脏多学科团队（MDT）对结直肠癌肝转移（CRCLM）患者进行评估，可提高切除率并改善生存。本研究的目的是评估如果所有 CRCLM 患者均通过肝脏 MDT 进行评估，是否可以提高潜在的切除率。
对 2008 年在大斯德哥尔摩地区诊断为结直肠癌的患者进行了回顾性分析。在虚构的肝脏 MDT 中，对所有在 5 年随访期间发现的肝转移患者（LM）进行了重新评估，评估中提供了先前的影像学研究、肿瘤特征、病史以及患者自身的治疗偏好。比较了每位患者的治疗决策与最初的治疗方案。估计了与转至肝脏 MDT 相关的因素的比值比（OR）和 95%置信区间。
在 272 例诊断为 LM 的患者中，102 例在原肝脏 MDT 中进行了讨论，最终有 69 例进行了切除。在虚构的肝脏 MDT 中，另外 22 例被认为是可切除/潜在可切除的患者，而这些患者之前均未由肝胆外科医生评估过。影响转至肝脏 MDT 的因素包括年龄（OR 3.12，1.72-5.65）、美国麻醉师协会（ASA）评分（OR 0.34，0.18-0.63；ASA 2 与 ASA 3）和 LM 的数量（OR 0.10，0.04-0.22；1-5 个 LM 与>10 个 LM），而性别（ = .194）和在教学医院治疗（ = .838）则没有影响。
大量的肝转移患者并未根据最佳现有证据进行治疗，且有很大的提高切除率的潜力。
在肝胆多学科会议中评估的结直肠癌伴肝转移患者的切除率更高，生存率也更高。不幸的是，并非所有可能受益于切除的患者都能得到适当的转诊。在这项研究中，通过重新评估来自基于人群的队列中所有的肝转移患者，包括有肝外转移的患者，同时考虑了合并症和患者自身对治疗的偏好，评估了潜在的更高切除率。另外 12.9%的患者可能被认为是潜在可切除的。结果突出了所有患者在肝胆多学科会议中进行评估的重要性。
