Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2019 Jan;26(1):275-281. doi: 10.1245/s10434-018-6945-0. Epub 2018 Oct 25.
After resection of colorectal liver metastases (CLM), up to 40% of patients will develop intrahepatic recurrence. This study aims to identify patterns of intrahepatic recurrence and their impact on survival after preoperative chemotherapy and CLM resection.
A retrospective review was performed of patients developing intrahepatic recurrence after CLM resection following preoperative chemotherapy. Prechemotherapy, preoperative, and postoperative computed tomography scans were reviewed. Recurrences were classified as in situ, de novo, or both in situ and de novo. Median follow-up was 42 months (range 2-144 months).
Among 223 patients meeting study criteria, intrahepatic recurrence was identified a median of 9 months after hepatectomy. Isolated de novo or in situ recurrence developed in 105 (47%) and 86 (39%) patients, respectively. Thirty-two patients (14%) developed both in situ and de novo recurrence, which was associated with significantly lower median overall survival of 33 months compared with 49 and 45 months with isolated in situ or de novo recurrence, respectively (p = 0.048). Among 118 patients (53%) who developed in situ recurrence as a component of disease relapse, recurrences resulted from disappearing or missed liver metastases in 47 patients (40%).
An intrahepatic recurrence pattern of both in situ and de novo metastases after CLM resection following preoperative chemotherapy predicts significantly worse overall survival compared with isolated in situ or de novo recurrence.
结直肠肝转移（CLM）切除术后，多达 40%的患者会出现肝内复发。本研究旨在确定肝内复发模式及其对术前化疗和 CLM 切除后生存的影响。
对接受术前化疗后 CLM 切除术后发生肝内复发的患者进行回顾性分析。回顾性分析术前、术前和术后 CT 扫描。将复发分为原位、新发或原位和新发均有。中位随访时间为 42 个月（范围 2-144 个月）。
在符合研究标准的 223 例患者中，肝切除后中位时间 9 个月发生肝内复发。105 例（47%）和 86 例（39%）患者分别出现孤立性新发或原位复发。32 例（14%）患者出现原位和新发均有复发，中位总生存期明显较低，为 33 个月，与孤立性原位或新发复发分别为 49 和 45 个月相比，差异有统计学意义（p=0.048）。在 118 例（53%）以原位复发为疾病复发的一部分的患者中，47 例（40%）复发是由于肝内转移灶消失或漏诊。
术前化疗后 CLM 切除术后肝内复发模式为原位和新发转移，与孤立性原位或新发复发相比，总生存期明显更差。
