门静脉栓塞术并不影响结直肠癌肝转移患者的长期生存和癌症复发风险：一项前瞻性队列研究。

Portal vein embolization does not affect the long-term survival and risk of cancer recurrence among colorectal liver metastases patients: A prospective cohort study.

机构信息

Service de chirurgie générale, Département de chirurgie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.

出版信息

Int J Surg. 2019 Jan;61:42-47. doi: 10.1016/j.ijsu.2018.11.029. Epub 2018 Dec 8.

DOI:10.1016/j.ijsu.2018.11.029

PMID:30537548

Abstract

BACKGROUND

Previous studies comparing the survival outcomes of liver resections with and without preoperative portal vein embolization (PVE) for colorectal liver metastases (CLM) have linked PVE to higher rate of tumor progression, lower overall survival (OS) and lower disease-free survival (DFS). The lack of adjusted models to compare these outcomes is a limitation of these studies since patients requiring PVE may differ significantly from the ones receiving upfront surgery.

MATERIALS AND METHODS

Prospective cohort study of 128 patients undergoing CLM resection. The OS analysis followed an intent-to-treat (ITT) approach. The adjusted impact of PVE on OS and DFS was evaluated using multivariate Cox regression models.

RESULTS

Seventy-one patients underwent PVE before attempting a liver resection while 57 received upfront surgery (NoPVE). All NoPVE patients were resected while 14 PVE participants (19.7%) were not operated (tumor progression = 9/14). PVE patients had a significantly higher preoperative lesions count (3 [1.75-4] vs 1 [1-2.5]; p < 0.001), a higher prevalence of bilateral metastases (23.5% vs 8.8, p = 0.028) and a higher count of neo-adjuvant chemotherapy cycles compared to NoPVE patients. The OS of PVE patients was similar to NoPVE participants (44.7 months [26.9-69.5] vs 49.0 [24.9-64.8], p = 0.761). The DFS of resected PVE patients was higher than NoPVE patients (33.2 months [10.7-54.6] vs 23.4 months [14.1-58.1], p = 0.991). In the adjusted models, preoperative lesions count was the only significant predictor of overall mortality (HR+IC = 1.06 (1.02-1.11) p = 0.005) and cancer recurrence (HR+IC = 1.14 (1.03-1.27) p = 0.012).

CONCLUSION

In the context of CLM, patients requiring PVE differ significantly from patients receiving upfront surgery. This confirms the need for adjusted models when comparing the clinical outcomes of both groups. Our adjusted analysis suggests that PVE is not a significant predictor of a lower OS or DFS. PVE allowed the resection of 80% of participants with initially unresectable CLM.

INSTITUTIONAL PROTOCOL NUMBER

12.106 STUDY REGISTRATION NUMBER: NCT03168230.

摘要

背景

先前比较结直肠癌肝转移（CLM）患者行肝切除术时是否行术前门静脉栓塞术（PVE）的生存结局的研究表明，PVE 与更高的肿瘤进展率、更低的总生存（OS）和无病生存（DFS）相关。这些研究的一个局限性是缺乏调整模型来比较这些结局，因为需要 PVE 的患者与接受直接手术的患者可能存在显著差异。

材料和方法

对 128 例接受 CLM 切除术的患者进行前瞻性队列研究。OS 分析采用意向治疗（ITT）方法。使用多变量 Cox 回归模型评估 PVE 对 OS 和 DFS 的调整影响。

结果

71 例患者在尝试肝切除术前接受了 PVE，57 例患者未接受 PVE（NoPVE）。所有 NoPVE 患者均行切除术，而 14 例 PVE 患者（19.7%）未行手术（肿瘤进展=9/14）。PVE 患者术前病变数量明显更高（3 [1.75-4] vs 1 [1-2.5]；p<0.001），双侧转移的发生率更高（23.5% vs 8.8%，p=0.028），新辅助化疗周期数也高于 NoPVE 患者。PVE 患者的 OS 与 NoPVE 患者相似（44.7 个月[26.9-69.5] vs 49.0 [24.9-64.8]，p=0.761）。接受切除术的 PVE 患者的 DFS 高于 NoPVE 患者（33.2 个月[10.7-54.6] vs 23.4 个月[14.1-58.1]，p=0.991）。在调整模型中，术前病变数量是总死亡率（HR+IC=1.06（1.02-1.11），p=0.005）和癌症复发（HR+IC=1.14（1.03-1.27），p=0.012）的唯一显著预测因子。