针对结直肠癌肝转移反复复发的积极多学科局部治疗方法。
Aggressive and Multidisciplinary Local Approach to Iterative Recurrences of Colorectal Liver Metastases.
作者信息
Viganò Luca, Pedicini Vittorio, Comito Tiziana, Carnaghi Carlo, Costa Guido, Poretti Dario, Franzese Ciro, Personeni Nicola, Del Fabbro Daniele, Rimassa Lorenza, Scorsetti Marta, Santoro Armando, Solbiati Luigi, Torzilli Guido
机构信息
Department of Surgery - Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano - Milan, Italy.
出版信息
World J Surg. 2018 Aug;42(8):2651-2659. doi: 10.1007/s00268-018-4525-x.
BACKGROUND
Liver resection (LR) of colorectal metastases is associated with high recurrence risk. Aggressive local retreatment is advocated, but further recurrences may occur. Poor is known about presentation, treatment, and outcome of iterative recurrences.
METHODS
A series of 323 consecutive patients undergoing first LR in the period 2004-2013 was reviewed. Patients with recurrence were included. Any local treatment (surgery, radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT)) was analyzed. If first recurrence (1st Rec) was treated, further recurrences and treatments were considered.
RESULTS
Overall, 206 (63.8%) patients had 1st Rec; 105 (51.0%) were treated (72 surgery, 19 RFA, 14 SBRT). Among treated patients, 78.1% had 2nd Rec, 74.4% 3rd Rec, 72.2% 4th Rec. Liver involvement progressively decreased (from 81.6 to 30.8%), and pulmonary one increased (from 23.3 to 53.8%). The proportion of treated patients remained stable (1st Rec = 51%, 2nd Rec = 55%, 3rd Rec = 56.3%, 4th Rec = 69.2%): surgery and RFA decreased (from 35.4 to 23.1%; from 9.2 to 0%) and SBRT increased (from 6.8 to 46.2%). Overall, 105 patients received 205 treatments (133 operations in 80 patients). Surgery had the best local disease control: at 2 years 93.4% versus RFA 56.4% (p = 0.0008) and SBRT 74.0% (p = 0.051). In comparison with chemotherapy, recurrence treatment improved survival after 1st Rec (3-year survival 62.9 vs. 13.4%, p < 0.0001), 2nd Rec (61.3 vs. 22.5%, p < 0.0001), and 3rd Rec (2-year survival 88.9 vs. 30.8%, p = 0.005).
CONCLUSIONS
Aggressive local treatment of recurrent metastases may improve survival, even in the case of iterative recurrences and extrahepatic lesions. Surgery is the standard, but a multidisciplinary approach should be adopted to enlarge the pool of treatable patients.
背景
结直肠癌肝转移灶的肝切除（LR）与高复发风险相关。提倡积极的局部再治疗，但可能会出现进一步复发。对于反复复发的表现、治疗及结局了解甚少。
方法
回顾了2004年至2013年期间连续接受首次LR的323例患者。纳入复发患者。分析了所有局部治疗（手术、射频消融（RFA）和立体定向体部放射治疗（SBRT））。若首次复发（第1次复发）得到治疗，则考虑进一步复发及治疗情况。
结果
总体而言，206例（63.8%）患者出现第1次复发；105例（51.0%）接受了治疗（72例手术、19例RFA、14例SBRT）。在接受治疗的患者中，78.1%出现第2次复发，74.4%出现第3次复发，72.2%出现第4次复发。肝转移逐渐减少（从81.6%降至30.8%），肺转移增加（从23.3%升至53.8%）。接受治疗的患者比例保持稳定（第1次复发 = 51%，第2次复发 = 55%，第3次复发 = 56.3%，第4次复发 = 69.2%）：手术和RFA减少（从35.4%降至23.1%；从9.2%降至0%），SBRT增加（从6.8%升至46.2%）。总体而言，105例患者接受了205次治疗（80例患者接受了133次手术）。手术的局部疾病控制效果最佳：2年时为93.4%，而RFA为56.4%（p = 0.0008），SBRT为74.0%（p = 0.051）。与化疗相比，复发治疗改善了第1次复发（3年生存率62.9%对13.4%，p < 0.0001）、第2次复发（61.3%对22.5%，p < 0.0001）和第3次复发（2年生存率88.9%对30.8%，p = 0.005）后的生存率。
结论
即使对于反复复发和肝外病变，积极的局部复发性转移瘤治疗也可能改善生存率。手术是标准治疗方法，但应采用多学科方法以扩大可治疗患者群体。
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