Dupré Aurélien, Malik Hassan Z, Jones Robert P, Diaz-Nieto Rafael, Fenwick Stephen W, Poston Graeme J
Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK; Centre Léon Bérard, Department of Surgical Oncology, Lyon, F-69008, France.
Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
Eur J Surg Oncol. 2018 Jan;44(1):80-86. doi: 10.1016/j.ejso.2017.10.218. Epub 2017 Nov 21.
The prognosis of patients undergoing liver resection for colorectal liver metastases (CLM) seems to be altered when the primary tumour is right-sided. However, data are lacking and conflicting. We aimed to evaluate the influence of the primary tumour location on oncologic outcomes following such surgery.
We retrospectively analysed prospectively collected data from 376 consecutive patients who underwent liver surgery for CLM between June 2010 and August 2015. We compared the outcomes of patients with right colon tumours and those with left colorectal tumours. The splenic flexure was used as the cut-off point to determine the anatomic primary site.
Among the 364 patients eligible, 74 (20.3%) had a right-sided primary tumour. These patients were older, had a poorer American Society of Anaesthesiologists status and had fewer node-positive primary tumours. The CLM characteristics were similar between both groups. Median PFS was not significantly different between the two groups at 9.9 months, as well as the pattern of recurrence. Median OS was shorter for patients with right-sided primary tumour (34.6 versus 45.3 months, p = 0.035). Similar results were observed when patients with rectal tumour were excluded from analysis (34.6 vs. 47.5 months, p = 0.007). Primary tumour site was an independent prognosis factor in multivariate analysis.
Right-sided location of the primary tumour is associated with worse OS after surgery for CLM, but seems to have no influence on PFS, and on the pattern of recurrence.
对于接受结直肠癌肝转移（CLM）肝切除术的患者，当原发肿瘤位于右侧时，其预后似乎会发生改变。然而，相关数据缺乏且相互矛盾。我们旨在评估原发肿瘤位置对这类手术后肿瘤学结局的影响。
我们回顾性分析了2010年6月至2015年8月期间连续376例接受CLM肝手术患者的前瞻性收集数据。我们比较了右半结肠癌患者和左半结肠癌患者的结局。以脾曲作为确定解剖学原发部位的分界点。
在364例符合条件的患者中，74例（20.3%）有右侧原发肿瘤。这些患者年龄较大，美国麻醉医师协会状态较差，且原发肿瘤淋巴结阳性较少。两组的CLM特征相似。两组的中位无进展生存期（PFS）无显著差异，均为9.9个月，复发模式也相似。右侧原发肿瘤患者的中位总生存期（OS）较短（34.6个月对45.3个月，p = 0.035）。当排除直肠肿瘤患者进行分析时，观察到类似结果（34.6个月对47.5个月，p = 0.007）。在多变量分析中，原发肿瘤部位是一个独立的预后因素。
原发肿瘤位于右侧与CLM手术后较差的OS相关，但似乎对PFS和复发模式没有影响。
