Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Int J Clin Oncol. 2018 Oct;23(5):908-916. doi: 10.1007/s10147-018-1273-8. Epub 2018 Apr 4.
Although recurrence after hepatectomy for colorectal liver metastases (CRLM) is common, the optimal treatment strategy remains unclear. The aims of this study were to clarify the impact of repeat surgery and identify the predictive factors for repeat surgery.
Among the 170 patients who underwent potentially curative surgery for CRLM, 113 developed recurrence. The predictive factors for the performance of repeat surgery were identified and a predictive model was constructed.
The patterns of recurrence were as follows; single site [n = 100 (liver, n = 61; lung, n = 22; other, n = 17)], multiple site (n = 13). Repeat surgery was performed in 54 patients (47.8%) including re-hepatectomy (n = 25), radiofrequency ablation (n = 12), and resection of the extrahepatic recurrent disease (n = 17), and their overall survival (OS) was significantly better than that of those who could not (5-year OS 60.7 vs 19.5%, P < 0.0001). A multivariate analysis revealed that a primary N-negative status [relative risk (RR) 2.93, P = 0.017], indocyanine retention rate at 15 min ≤ 10% before hepatectomy (RR 2.49, P = 0.04), and carcinoembryonic antigen ≤ 5 ng/mL before hepatectomy (RR 2.96, P = 0.017) independently predicted the performance of repeat surgery. For patients who did not present any factors, the probability of repeat surgery was 19.6%. The addition of each subsequent factor increased the probability to 41.9, 67.8, and 84.0% (for 1, 2, and 3 factors, respectively).
Repeat surgery for not only intrahepatic but also extrahepatic recurrence is crucial for prolonging the survival of CRLM patients. The proposed model may help to predict the possibility of repeat surgery and provide optimal individualized treatment.
尽管肝切除术治疗结直肠癌肝转移（CRLM）后复发较为常见，但最佳治疗策略仍不明确。本研究旨在阐明再次手术的影响，并确定再次手术的预测因素。
在 170 例接受潜在根治性手术治疗的 CRLM 患者中，有 113 例出现复发。确定了再次手术的预测因素，并构建了预测模型。
复发模式如下：单部位[100 例（肝脏，61 例；肺部，22 例；其他部位，17 例）]，多部位（13 例）。54 例患者接受了再次手术（47.8%），包括再次肝切除术（n=25）、射频消融术（n=12）和肝外复发性疾病切除术（n=17），其总体生存率（OS）显著优于不能接受再次手术者（5 年 OS：60.7%比 19.5%，P<0.0001）。多因素分析显示，原发 N 阴性状态（相对风险[RR]2.93，P=0.017）、肝切除术前 15 分钟吲哚菁绿滞留率≤10%（RR2.49，P=0.04）和肝切除术前癌胚抗原≤5ng/ml（RR2.96，P=0.017）独立预测再次手术的疗效。对于没有任何因素的患者，再次手术的概率为 19.6%。每增加一个后续因素，再次手术的概率分别增加至 41.9%、67.8%和 84.0%（分别有 1、2 和 3 个因素）。
再次手术不仅针对肝内复发，也针对肝外复发，对延长 CRLM 患者的生存至关重要。所提出的模型可能有助于预测再次手术的可能性，并提供最佳的个体化治疗。
