Reding Daniel, Pestalozzi Bernhard Cornelius, Breitenstein Stefan, Stupp Roger, Clavien Pierre-Alain, Slankamenac Ksenija, Samaras Panagiotis
Department of Oncology, Swiss HPB-Centre, University Hospital Zurich, Switzerland.
Department of Visceral and Transplantation Surgery, Swiss HPB-Centre, University Hospital Zurich, Switzerland.
Swiss Med Wkly. 2017 Aug 15;147:w14486. doi: 10.4414/smw.2017.14486. eCollection 2017.
To report survival following different operative strategies and perioperative chemotherapy in patients with synchronous colorectal liver metastases in a tertiary academic referral centre.
We performed a retrospective analysis, based on a prospective database, of patients who presented with synchronous colorectal liver metastases. Follow-up data were obtained from medical records, letters or telephone contacts. The main endpoint was overall survival. An additional event of interest was postoperative mortality according to treatment strategy. Predefined variables were analysed to identify associated risk factors.
Overall, 109 patients undergoing liver resection for synchronous colorectal liver metastases between 2000 and 2010 were identified. The majority of patients had resection of the primary tumour first (n = 82), the classic approach; notably fewer were treated according to a combined (n = 20) or a reverse "liver first" strategy (n = 7). Most patients (92%) received preoperative, interval and/or postoperative chemotherapy. Median overall survival of the entire population was 33.6 months (interquartile range [IQR] 11-92.7 months). Patients undergoing classic surgery had a median overall survival of 40.3 months (IQR 14.9-96.6 months). The 3-year survival rates of the three patient groups were 53% in the classic, 47% in the combined and 58% in the reverse group. The lowest rate of 180-day mortality (9%) was after the classic surgical approach. On a multivariate Cox proportional hazards regression analysis, patient age >60 years (hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.1-3.9; p = 0.018), R2-status (HR 2.08, 95% CI 1.03-4.2; p = 0.040), and >4 liver metastases (HR 2.4, 95% CI 1.2-4.6; p = 0.011) were associated significantly with worse overall survival.
In patients undergoing surgical resection for synchronous colorectal liver metastases, promising survival rates could be achieved, irrespective of the chosen surgical strategy. The presence of five or more liver metastases, patient age over 60 years and R2-status were found to be adverse risk factors.
在一家三级学术转诊中心报告同步性结直肠癌肝转移患者采用不同手术策略及围手术期化疗后的生存率。
我们基于一个前瞻性数据库，对出现同步性结直肠癌肝转移的患者进行了回顾性分析。随访数据通过病历、信件或电话联系获取。主要终点是总生存期。另一个感兴趣的事件是根据治疗策略的术后死亡率。对预定义变量进行分析以确定相关危险因素。
总体而言，确定了2000年至2010年间109例因同步性结直肠癌肝转移接受肝切除术的患者。大多数患者首先切除原发肿瘤（n = 82），即经典方法；采用联合（n = 20）或反向“肝优先”策略（n = 7）治疗的患者明显较少。大多数患者（92%）接受了术前、间期和/或术后化疗。整个人群的中位总生存期为33.6个月（四分位间距[IQR] 11 - 92.7个月）。接受经典手术的患者中位总生存期为40.3个月（IQR 14.9 - 96.6个月）。三组患者的3年生存率分别为：经典组53%，联合组47%，反向组58%。经典手术方法后的180天死亡率最低（9%）。在多因素Cox比例风险回归分析中，患者年龄>60岁（风险比[HR] 2.1，95%置信区间[CI] 1.1 - 3.9；p = 0.018）、R2状态（HR 2.08，95% CI 1.03 - 4.2；p = 0.040）以及肝转移>4个（HR 2.4，95% CI 1.2 - 4.6；p = 0.011）与较差的总生存期显著相关。
在因同步性结直肠癌肝转移接受手术切除的患者中，无论选择何种手术策略，均可实现有前景的生存率。发现存在五个或更多肝转移、患者年龄超过60岁以及R2状态是不良风险因素。
