Hirokawa Fumitoshi, Asakuma Mitsuhiro, Komeda Koji, Shimizu Tetsunosuke, Inoue Yoshihiro, Kagota Syuji, Tomioka Atsushi, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Surg Today. 2019 Jan;49(1):82-89. doi: 10.1007/s00595-018-1716-x. Epub 2018 Sep 25.
Neoadjuvant chemotherapy (NAC) for resectable liver metastasis from colorectal cancer (CRLM) is used widely, but its efficacy lacks clear evidence. This study aimed to clarify its worth and develop appropriate treatment strategies for CRLM.
We analyzed, retrospectively, the clinicopathological factors and outcomes of 137 patients treated for resectable CRLM between 2006 and 2015, with upfront surgery (NAC group; n = 117) or initial NAC treatment (NAC group; n = 20).
The time to surgical failure (TSF) and overall survival (OS) after initial treatment were significantly worse in the NAC group than in the NAC group (P = 0.002 and P = 0.032, respectively). At hepatectomy, the NAC group had a lower median prognostic nutrition index (PNI), higher rates of a positive Glasgow Prognostic Score (P = 0.002) and more perioperative blood transfusions (P = 0.027) than the NAC group. Moreover, the serum albumin (P = 0.006), PNI (P ≤ 0.001) and lymphocyte-to-monocyte ratio (P ≤ 0.001) were significantly decreased and the GPS positive rate was increased from 15 to 35% in the NAC group. The OS rates did not differ significantly according to the NAC response (5-year OS rates-CR/PR 67%, SD 60%, PD 38%).
Patients with resectable CRLM should undergo upfront hepatectomy because NAC did not improve OS after initial treatment in these patients.
新辅助化疗（NAC）用于可切除的结直肠癌肝转移（CRLM）已被广泛应用，但其疗效缺乏明确证据。本研究旨在阐明其价值并为CRLM制定合适的治疗策略。
我们回顾性分析了2006年至2015年间137例接受可切除CRLM治疗患者的临床病理因素及预后，其中先行手术（非NAC组；n = 117）或初始NAC治疗（NAC组；n = 20）。
初始治疗后的手术失败时间（TSF）和总生存期（OS）在NAC组显著差于非NAC组（分别为P = 0.002和P = 0.032）。在肝切除时，NAC组的中位预后营养指数（PNI）较低，格拉斯哥预后评分阳性率较高（P = 0.002），围手术期输血次数更多（P = 0.027）。此外，NAC组血清白蛋白（P = 0.006）、PNI（P≤0.001）和淋巴细胞与单核细胞比值（P≤0.001）显著降低，GPS阳性率从15%升至35%。根据NAC反应，OS率无显著差异（5年OS率——完全缓解/部分缓解67%，疾病稳定60%，疾病进展38%）。
可切除CRLM患者应先行肝切除，因为NAC未能改善这些患者初始治疗后的OS。
