接受结直肠癌肝寡转移灶根治性切除患者的早期复发：其临床特征、危险因素及预后的识别
Early recurrence in patients undergoing curative resection of colorectal liver oligometastases: identification of its clinical characteristics, risk factors, and prognosis.
作者信息
Lin Junzhong, Peng Jianhong, Zhao Yixin, Luo Baojia, Zhao Yujie, Deng Yuxiang, Sui Qiaoqi, Gao Yuanhong, Zeng Zhifan, Lu Zhenhai, Pan Zhizhong
机构信息
State Key Laboratory of Oncology in South China, Department of Colorectal Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
出版信息
J Cancer Res Clin Oncol. 2018 Feb;144(2):359-369. doi: 10.1007/s00432-017-2538-8. Epub 2017 Nov 11.
PURPOSE
Oligometastatic disease can potentially be cured when an optimal approach is performed. Early recurrence after liver resection is an intractable problem, and the clinical implications remain unknown in colorectal liver oligometastases (CLOM) patients. This study aimed to investigate the clinical characteristics, risk factors, and prognosis related to early recurrence in these patients.
METHODS
A total of 307 consecutive patients with CLOM undergoing curative liver resection were retrospectively reviewed between September 1999 and June 2016. Early recurrence was defined as any recurrence or death from CLOM that occurred within 6 months of liver resection.
RESULTS
With a median follow-up time of 31.7 months, the 3-year overall survival (OS) and recurrence-free survival rates were 68.7 and 42.5%, respectively. Forty-nine (16.0%) patients developed early recurrence and showed a poorer 3-year OS than those with non-early recurrence (22.3 vs. 75.8%, P < 0.001) or later recurrence (22.3 vs. 52.8 vs. 63.2%, P < 0.001). Moreover, early recurrence was identified as an independent predictor of 3-year OS [hazard ratio (HR) 6.282; 95% confidence interval (CI) 3.980-9.915, P < 0.001]. In multivariate analysis, a node-positive primary tumor [odds ratio (OR) 2.316; 95% CI 1.097-4.892, P = 0.028) and metastatic diameter > 3 cm (OR 2.560; 95% CI 1.290-5.078; P = 0.007) were shown to be risk factors for early recurrence. The salvage liver resection rate for patients with early recurrence was significantly lower than that for patients with later recurrence (4.1 vs. 19.7%, P = 0.010).
CONCLUSIONS
Early recurrence should be investigated in routine clinical practice, even in patients with CLOM after curative liver resection. Detailed preoperative comprehensive measurements might help stratify high-risk patients, and a non-surgical treatment for early recurrence might represent an effective alternative.
目的
当采用最佳治疗方法时，寡转移疾病有可能被治愈。肝切除术后早期复发是一个棘手的问题，在结直肠癌肝寡转移（CLOM）患者中其临床意义仍不明确。本研究旨在调查这些患者早期复发的临床特征、危险因素及预后。
方法
回顾性分析了1999年9月至2016年6月期间连续接受根治性肝切除的307例CLOM患者。早期复发定义为肝切除术后6个月内发生的任何CLOM复发或死亡。
结果
中位随访时间为31.7个月，3年总生存率（OS）和无复发生存率分别为68.7%和42.5%。49例（16.0%）患者发生早期复发，其3年OS较非早期复发患者差（22.3%对75.8%，P<0.001）或较晚期复发患者差（22.3%对52.8%对63.2%，P<0.001）。此外，早期复发被确定为3年OS的独立预测因素[风险比（HR）6.282；95%置信区间（CI）3.980 - 9.915，P<0.001]。多因素分析显示，原发肿瘤淋巴结阳性[比值比（OR）2.316；95%CI 1.097 - 4.892，P = 0.028]和转移灶直径>3 cm（OR 2.560；95%CI 1.290 - 5.078；P = 0.007）是早期复发的危险因素。早期复发患者的挽救性肝切除率显著低于晚期复发患者（4.1%对19.7%，P = 0.010）。
结论
即使在根治性肝切除术后的CLOM患者中，常规临床实践中也应调查早期复发情况。详细的术前综合评估可能有助于对高危患者进行分层，对早期复发采用非手术治疗可能是一种有效的替代方法。
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