Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center, New York, NY.
Surgery. 2018 Jun;163(6):1238-1244. doi: 10.1016/j.surg.2018.01.004. Epub 2018 Feb 15.
Hepatic resection of colorectal liver metastases is associated with long-term survival. This study analyzes actual 10-year survivors after resection of colorectal liver metastases, reports the observed rate of cure, and identifies factors that preclude cure.
A single-institution, prospectively maintained database was queried for all initial resections for colorectal liver metastases for the years 1992-2004. Observed cure was defined as actual 10-year survival with either no recurrence or resected recurrence with at least 3 years of disease-free follow-up. Clinical risk score was dichotomized into low (0-2) and high (3-5). Semiparametric proportional hazards mixture cure model was utilized to estimate probability of cure.
We included 1,211 patients with a median follow-up for survivors of 11 years. Median disease-specific survival was 4.9 years (95% CI: 4.4-5.3). 295 patients (24.4%) were actual 10-year survivors. The observed cure rate was 20.6% (n = 250). Among 250 cured patients, 192 (76.8%) had no recurrence and 58 (23.2%) had a resected recurrence with at least 3 years of disease-free follow-up. Extrahepatic disease (n = 88), carcinoembryonic antigen >200 ng/mL (n = 119), positive margin (n = 109), and >10 tumors (n = 31) had observed cure rates less than 10%. In cure model analysis, patients with both extrahepatic disease and high clinical risk score (n = 31) had an estimated probability of cure of 3.5%.
Actual 10-year survival after resection of colorectal liver metastases is 24% with an observed 20% cure rate. Patients with both high clinical risk score and extrahepatic disease have an estimated probability of cure less than 5%. When such factors are identified, strong consideration may be given to preoperative strategies, such as neoadjuvant chemotherapy, to help select patients for surgical therapy.
结直肠肝转移灶的肝切除术与长期生存相关。本研究分析了肝切除术后实际 10 年生存者，报告了观察到的治愈率，并确定了不能治愈的因素。
对 1992 年至 2004 年所有初始结直肠肝转移灶切除术的单机构前瞻性维护数据库进行了查询。观察到的治愈率定义为实际 10 年生存且无复发或切除复发且至少 3 年无病随访的患者比例。临床风险评分分为低（0-2）和高（3-5）。半参数比例风险混合治愈率模型用于估计治愈率。
共纳入 1211 例患者，幸存者中位随访时间为 11 年。中位疾病特异性生存率为 4.9 年（95%CI：4.4-5.3）。295 例患者（24.4%）为实际 10 年幸存者。观察到的治愈率为 20.6%（n=250）。在 250 例治愈患者中，192 例（76.8%）无复发，58 例（23.2%）有切除复发且至少 3 年无病随访。肝外疾病（n=88）、癌胚抗原>200ng/mL（n=119）、阳性切缘（n=109）和>10 个肿瘤（n=31）的观察治愈率均<10%。在治愈率模型分析中，同时患有肝外疾病和高临床风险评分的患者（n=31）的估计治愈率为 3.5%。
结直肠肝转移灶切除术后实际 10 年生存率为 24%，观察到的治愈率为 20%。同时患有高临床风险评分和肝外疾病的患者估计治愈率<5%。当识别出这些因素时，可以考虑术前策略，如新辅助化疗，以帮助选择接受手术治疗的患者。
