Glisson 囊浸润对接受结直肠癌肝转移切除术患者的意义。

Significance of Glisson's capsule invasion in patients with colorectal liver metastases undergoing resection.

机构信息

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

出版信息

Am J Surg. 2019 Nov;218(5):887-893. doi: 10.1016/j.amjsurg.2019.01.023. Epub 2019 Jan 25.

DOI:10.1016/j.amjsurg.2019.01.023

PMID:30712864

Abstract

BACKGROUND

Significance of Glisson's capsule invasion in colorectal liver metastases (CLM) patients undergoing resection has been little investigated.

METHODS

CLM patients (244) with curative resection (2011-2016) were divided into two groups: patients with (Group 1; n = 49 [20%]) and without (Group 2; n = 195 [80%]) histologically-proven Glisson invasion. Eight (16%) Group 1 patients were identified by pre- or intra-operative findings. We compared characteristics between Groups 1 and 2 and determined independent prognosticators.

RESULTS

Group 1 was more commonly associated with right-sided primary, CLM>5 cm, and R1 resections. Independent factors on reduced OS in entire cohort were pre-surgical chemotherapy [hazard ratio (HR): 2.68, P = 0.001], CLM>5 cm (HR: 4.39, P = 0.002), moderate or poor differentiation (HR: 2.38, P = 0.004), and R1 resection (HR: 1.92, P = 0.035).

CONCLUSIONS

CLM Glisson invasion was significantly associated with R1 resection. Advancements in determining Glisson invasion pre- or intra-operatively might produce benefits for CLM patients undergoing resection by reducing R1 resection.

摘要

背景

在接受切除术的结直肠癌肝转移（CLM）患者中，Glisson 囊侵犯的意义尚未得到充分研究。

方法

将 2011 年至 2016 年期间接受根治性切除术的 244 例 CLM 患者分为两组：有（第 1 组；n=49[20%]）和无（第 2 组；n=195[80%]）组织学证实的 Glisson 侵犯的患者。第 1 组中有 8 例（16%）患者通过术前或术中发现。我们比较了两组之间的特征，并确定了独立的预后因素。

结果

第 1 组更常与右侧原发性肿瘤、CLM>5cm 和 R1 切除术相关。整个队列中降低 OS 的独立因素是术前化疗[风险比（HR）：2.68，P=0.001]、CLM>5cm（HR：4.39，P=0.002）、中或低分化（HR：2.38，P=0.004）和 R1 切除术（HR：1.92，P=0.035）。