Makowiec Frank, Bronsert Peter, Klock Andrea, Hopt Ulrich T, Neeff Hannes P
Department of Surgery, University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany.
Comprehensive Cancer Center, University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany.
Int J Colorectal Dis. 2018 Jan;33(1):71-78. doi: 10.1007/s00384-017-2916-3. Epub 2017 Nov 2.
Modern chemotherapy (CTX) increases survival in stage IV colorectal cancer. In colorectal liver metastases (CLM), neoadjuvant (neo) CTX may increase resectability and improve survival. Due to widespread use of CTX in CLM, recent studies assessed the role of the hepatic margin after CTX, with conflicting results. We evaluated the outcome after resection of CLM in relation to CTX and hepatic resection status.
Since 2000, 334 patients with first hepatic resection for isolated CLM were analyzed. Thirty-two percent had neoadjuvant chemotherapy (targeted therapy in 42%). Sixty-eight percent never had CTX before hepatectomy or longer than 6 months before resection. The results were gained by analysis of our prospective database.
Positive hepatic margins occurred in 8% (independent of neoCTx). Patients after neoCTX had higher numbers of CLM (p < 0.01) and a longer duration of surgery (p < 0.03). After hepatectomy, 5-year survival was 45% and correlated strongly with the margin status (47% in R-0 and 21% in R-1; p < 0.001). Survival also correlated with margin status in the subgroups with neoCTX (p < 0.01) or without neoCTx (p < 0.01). In multivariate analysis of the entire group, hepatic margin status (RR 3.2; p < 0.001) and age > 65 years (RR 1.6; p < 0.01) were associated with poorer survival. In the subgroup of patients after neoCTX (n = 106), only the resection margin was an independent predictor of survival (p < 0.001).
In patients with isolated colorectal liver metastases undergoing resection, the hepatic margin status was the strongest independent prognostic factor. This effect was also present after neoadjuvant chemotherapy for CLM.
现代化疗（CTX）可提高IV期结直肠癌患者的生存率。在结直肠癌肝转移（CLM）中，新辅助（neo）CTX可能会提高可切除性并改善生存率。由于CTX在CLM中广泛应用，近期研究评估了CTX后肝切缘的作用，但结果相互矛盾。我们评估了CLM切除术后与CTX和肝切除状态相关的结局。
自2000年以来，对334例因孤立性CLM首次进行肝切除的患者进行了分析。32%的患者接受了新辅助化疗（42%为靶向治疗）。68%的患者在肝切除术前从未接受过CTX或在切除前超过6个月未接受过CTX。结果通过对我们的前瞻性数据库进行分析得出。
8%的患者出现肝切缘阳性（与新辅助CTX无关）。接受新辅助CTX的患者CLM数量更多（p<0.01），手术时间更长（p<0.03）。肝切除术后，5年生存率为45%，与切缘状态密切相关（R-0为47%，R-1为21%；p<0.001）。新辅助CTX亚组（p<0.01）和未接受新辅助CTX亚组（p<0.01）的生存率也与切缘状态相关。在整个组的多因素分析中，肝切缘状态（风险比3.2；p<0.001）和年龄>65岁（风险比1.6；p<0.01）与较差的生存率相关。在新辅助CTX后的患者亚组（n=106）中，只有切除切缘是生存的独立预测因素（p<0.001）。
在接受切除的孤立性结直肠癌肝转移患者中，肝切缘状态是最强的独立预后因素。在CLM新辅助化疗后这种影响也存在。
