Memeo Riccardo, de Blasi Vito, Adam Rene, Goéré Diane, Piardi Tullio, Lermite Emilie, Turrini Olivier, Navarro Francis, de'Angelis Nicola, Cunha Antonio Sa, Pessaux Patrick
Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France.
Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France.
World J Surg. 2018 Mar;42(3):892-901. doi: 10.1007/s00268-017-4229-7.
The width of resection margin is still a matter of debate in case of colorectal liver metastasis resection. The aim of this study was to determine the risk factors for R1 resection. Once risk factors had been identified, patients were matched according to Fong's prognostic criteria, in order to evaluate whether R1 resection still remained a negative prognostic factor impacting overall and disease-free survival.
A total of 1784 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were compared before and after a 1:1 propensity score analysis in order to compare R0 versus R1 resections according to Fong criteria.
Primary tumor nodes found positive after colorectal resection (RR = 1.20, p = 0.02), operative time (> 240 min) (RR = 1.26, p = 0.05), synchronous liver metastasis (RR = 1.27, p = 0.02), pedicle clamping (> 40 min) (RR = 1.52, p = 0.001), lesion size larger than 50 mm (RR = 1.54, p = 0.001), rehepatectomy (RR = 1.68, p = 0.001), more than 3 lesions (RR = 1.69, p = 0.0001), and bilateral lesions (RR = 1.74, p = 0.0001) were identified as risk factors in multivariate analysis. After a 1:1 PSM according to Fong criteria, R1 resection still remained a negative prognostic factor impacting overall and disease-free survival, with 1-, 3-, 5-year OS at 94, 81, and 70% in R0 and 92, 75, and 58% in R1, respectively, (p = 0.008), and disease-free survival (DFS) with 1-, 3-, 5-year survival at 64, 41, and 28% in R0 versus 51, 28, and 18% in R1 (p = 0.0002), respectively.
Even after using PSM as an oncological prognostic criterion, R1 resection still impacts overall and disease-free survival negatively.
在结直肠癌肝转移切除术的情况下，手术切缘宽度仍是一个有争议的问题。本研究的目的是确定R1切除的危险因素。一旦确定了危险因素，就根据方氏预后标准对患者进行匹配，以评估R1切除是否仍然是影响总生存期和无病生存期的不良预后因素。
对一个多中心回顾性肝切除队列中的1784例肝切除术进行分析。在1:1倾向评分分析前后对患者进行比较，以便根据方氏标准比较R0与R1切除。
多因素分析确定，结直肠切除术后原发肿瘤淋巴结阳性（RR = 1.20，p = 0.02）、手术时间（> 240分钟）（RR = 1.26，p = 0.05）、同时性肝转移（RR = 1.27，p = 0.02）、肝门阻断时间（> 40分钟）（RR =1.52，p = 0.001）、病变大小大于50 mm（RR = 1.54，p = 0.001）、再次肝切除术（RR = 1.68，p = 0.001）、超过3个病变（RR = 1.69，p = 0.0001）以及双侧病变（RR = 1.74，p = 0.0001）为危险因素。根据方氏标准进行1:1倾向评分匹配后，R1切除仍然是影响总生存期和无病生存期的不良预后因素，R0组1年、3年、5年总生存率分别为94%、81%和70%，R1组分别为92%、75%和58%（p = 0.008），无病生存期（DFS）方面，R0组1年、3年、5年生存率分别为64%、41%和28%，R1组分别为51%、28%和18%（p = 0.0002）。
即使将倾向评分匹配作为肿瘤学预后标准，R1切除仍然对总生存期和无病生存期有负面影响。
