Bartolini Ilenia, Ringressi Maria Novella, Melli Filippo, Risaliti Matteo, Brugia Marco, Mini Enrico, Batignani Giacomo, Bechi Paolo, Boni Luca, Taddei Antonio
Department of Surgery and Translational Medicine, University of Florence, AOU Careggi, Largo Brambilla 3, 50134 Florence, Italy.
Department of Experimental and Clinical Medicine, AOU Careggi, Largo Brambilla 3, 50134 Florence, Italy.
Gastroenterol Res Pract. 2018 Jul 11;2018:5353727. doi: 10.1155/2018/5353727. eCollection 2018.
Surgical treatment is the cornerstone in the management of colorectal cancer (CRC) liver metastases. The aim of this study is to identify clinicopathological factors affecting disease-free (DFS) and overall survival (OS) in patients undergoing potentially curative liver resection for CRC metastasis.
All consecutive patients undergoing liver resection for first recurrence of CRC from February 2006 to February 2018 were included. Prognostic impact of factors related to the patient, primary and metastatic tumors, was retrospectively tested through univariate and multivariate analyses.
Seventy patients were included in the study. Median postoperative follow-up was 37 months (range 1-119). Median DFS and OS were 15.2 and 62.7 months, and 5-year DFS and OS rates were 16% and 53%. In univariate analysis, timing of metastasis presentation/treatment (combined colorectal and liver resection, "bowel first" approach or metachronous presentation) ( < 0.0001), ASA score ( = 0.003), chemotherapy after liver surgery ( = 0.028), T stage ( = 0.021), number of resected liver lesions ( < 0.0001), and liver margin status ( = 0.032) was significantly associated with DFS while peritoneal resection at colorectal surgery ( = 0.026), ASA score ( = 0.036), extension of liver resection ( = 0.024), chemotherapy after liver surgery ( = 0.047), and positive nodes ( = 0.018) with OS. In multivariate analysis, timing of metastasis presentation/treatment, ASA score, and chemotherapy (before and after liver surgery) resulted significantly associated with DFS and timing of metastasis presentation/treatment, positive nodes, peritoneal resection at colorectal surgery, and surgical approach (open or minimally invasive) of colorectal resection with OS.
Surgery may provide good DFS and OS rates for CRC liver metastasis. Patient selection for surgery and correct timing of intervention within a multidisciplinary approach may be improved by taking into account negative prognostic factors which stress the importance of systemic therapy.
手术治疗是结直肠癌（CRC）肝转移治疗的基石。本研究旨在确定影响接受潜在根治性肝切除治疗CRC转移患者无病生存期（DFS）和总生存期（OS）的临床病理因素。
纳入2006年2月至2018年2月期间因CRC首次复发而接受肝切除的所有连续患者。通过单因素和多因素分析回顾性检验与患者、原发肿瘤和转移瘤相关因素的预后影响。
70例患者纳入本研究。术后中位随访时间为37个月（范围1 - 119个月）。中位DFS和OS分别为15.2个月和62.7个月，5年DFS和OS率分别为16%和53%。在单因素分析中，转移出现/治疗时间（结直肠和肝脏联合切除、“先处理肠道”方法或异时性出现）（<0.0001）、美国麻醉医师协会（ASA）评分（=0.003）、肝切除术后化疗（=0.028）、T分期（=0.021）、切除的肝转移灶数量（<0.0001）和肝切缘状态（=0.032）与DFS显著相关，而结直肠手术时的腹膜切除（=0.026）、ASA评分（=0.036）、肝切除范围（=0.024）、肝切除术后化疗（=0.047）和阳性淋巴结（=0.018）与OS相关。在多因素分析中，转移出现/治疗时间、ASA评分和化疗（肝切除术前和术后）与DFS显著相关，转移出现/治疗时间、阳性淋巴结、结直肠手术时的腹膜切除以及结直肠切除的手术方式（开放或微创）与OS相关。
手术可为CRC肝转移提供良好的DFS和OS率。通过考虑强调全身治疗重要性的负面预后因素，在多学科方法中改善手术患者的选择和正确的干预时机。
