肝切除术后辅助化疗对同时性和早期异时性结直肠癌肝转移的预后影响

Prognostic Impact of Adjuvant Chemotherapy after Hepatic Resection for Synchronous and Early Metachronous Colorectal Liver Metastases.

作者信息

Nishioka Yujiro, Moriyama Jin, Matoba Shuichiro, Kuroyanagi Hiroya, Hashimoto Masaji, Shindoh Junichi

机构信息

Hepatobiliary-Pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan.

出版信息

Dig Surg. 2018;35(3):187-195. doi: 10.1159/000478791. Epub 2017 Aug 19.

DOI:10.1159/000478791

PMID:28848205

Abstract

BACKGROUND

Although the usefulness of adjuvant chemotherapy has been established in the treatment for stages II/III colorectal cancer, its prognostic advantage for colorectal liver metastases (CLM) remains controversial.

METHODS

Two hundred and nine patients who underwent curative resection for CLM were reviewed. The potential advantage of adjuvant chemotherapy was investigated in 3 groups stratified by disease-free interval (DFI): synchronous CLM (S-CLM), early metachronous CLM (EM-CLM, DFI ≤1 year), and late metachronous CLM (LM-CLM, DFI >1 year).

RESULTS

Of the 105 patients who underwent adjuvant chemotherapy after surgery, 47 received uracil-tegafur and leucovorin (UFT/LV) while 58 received the oxaliplatin-based regimen. Five-year recurrence-free survival (RFS) rates in patients with/without adjuvant chemotherapy were 32.8/11.2% in S-CLM (p = 0.002), 43.7/15.2% in EM-CLM (p = 0.002), 44.1/29.6% in LM-CLM (p = 0.163), respectively. Five-year overall survival (OS) rates were 77.9/44.5% in S-CLM (p = 0.021), 81.5/39.5% in EM-CLM (p = 0.015), 76.1/65.4% in LM-CLM (p = 0.411), respectively. Multivariate analyses in S-CLM and EM-CLM indicated that adjuvant chemotherapy is correlated with better RFS and OS irrespective of the regimens, while the incidence of severe adverse event was significantly different between UFT/LV and oxaliplatin (6.8 vs. 50.9%, p < 0.0001).

CONCLUSION

Adjuvant chemotherapy might improve the clinical outcomes in S-CLM and EM-CLM. UFT/LV might be a choice for CLM in adjuvant settings in selected patients.

摘要

背景

尽管辅助化疗在II/III期结直肠癌治疗中的有效性已得到确立，但其对结直肠癌肝转移（CLM）的预后优势仍存在争议。

方法

回顾了209例行CLM根治性切除术的患者。根据无病间期（DFI）将患者分为3组，研究辅助化疗的潜在优势：同时性CLM（S-CLM）、早期异时性CLM（EM-CLM，DFI≤1年）和晚期异时性CLM（LM-CLM，DFI>1年）。

结果

105例术后接受辅助化疗的患者中，47例接受了替加氟尿嘧啶和亚叶酸钙（UFT/LV），58例接受了基于奥沙利铂的方案。S-CLM中接受/未接受辅助化疗患者的5年无复发生存率（RFS）分别为32.8%/11.2%（p = 0.002），EM-CLM中为43.7%/15.2%（p = 0.002），LM-CLM中为44.1%/29.6%（p = 0.163）。S-CLM的5年总生存率（OS）分别为77.9%/44.5%（p = 0.021），EM-CLM中为81.5%/39.5%（p = 0.015），LM-CLM中为76.1%/65.4%（p = 0.411）。S-CLM和EM-CLM的多因素分析表明，无论采用何种方案，辅助化疗均与更好的RFS和OS相关，而UFT/LV和奥沙利铂之间的严重不良事件发生率存在显著差异（6.8%对50.9%，p < 0.0001）。