Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, 100142, China.
Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, 100142, China.
Eur J Surg Oncol. 2019 Sep;45(9):1551-1558. doi: 10.1016/j.ejso.2019.03.010. Epub 2019 Mar 9.
The definition of R1 resection in colorectal cancer liver metastases (CRLM) remains debatable. This retrospective study was conducted to clarify the impact of R1 margin on patient survival after liver resection for CRLM, taking into consideration tumor biology, including RAS status and chemotherapy response.
We retrospectively analysed the clinical and survival data of 214 CRLM patients with initially resectable liver metastases who underwent liver resection after receiving neoadjuvant chemotherapy between January 2006 and December 2016.
R1 resection significantly impacted patients' overall survival (OS) and disease-free survival (DFS) in the overall patient cohort (5-year OS: 53.2% for R0 vs 38.2% for R1, P = 0.001; 5-year DFS: 26.5% for R0 vs 10.5% for R1, P = 0.002). In the RAS wild-type subgroup and respond to chemotherapy (RC) subgroup, R1 reached a similar OS to those who underwent R0 resection (RAS wild-type, P = 0.223; RC, P = 0.088). For the RAS mutated subgroup and no response to chemotherapy (NRC) subgroup, OS was significantly worse underwent R1 resection (RAS mutant, P = 0.002; NRC, P = 0.022). When considering tumor biology combining RAS and chemotherapy response status, R1 resection was only acceptable in patients with both RAS wild-type and RC (5-year OS: 66.4% for R0 vs 65.2% for R1, p = 0.884), but was significantly worse in those with either RAS mutation or NRC.
Tumor biology plays an important role in deciding the appropriate resection margin in patients with CRLM undergoing radical surgery. R1 resection margin is only acceptable in RAS wild-type patients who respond to chemotherapy.
结直肠癌肝转移（CRLM）的 R1 切除定义仍存在争议。本回顾性研究旨在阐明 R1 切缘对接受新辅助化疗后行肝切除术的 CRLM 患者生存的影响，同时考虑肿瘤生物学因素，包括 RAS 状态和化疗反应。
我们回顾性分析了 2006 年 1 月至 2016 年 12 月期间接受新辅助化疗后行肝切除术的 214 例最初可切除肝转移的 CRLM 患者的临床和生存数据。
R1 切除显著影响整体患者队列的总生存（OS）和无病生存（DFS）（5 年 OS：R0 组为 53.2%，R1 组为 38.2%，P=0.001；5 年 DFS：R0 组为 26.5%，R1 组为 10.5%，P=0.002）。在 RAS 野生型亚组和对化疗有反应（RC）亚组中，R1 达到与 R0 切除相似的 OS（RAS 野生型，P=0.223；RC，P=0.088）。对于 RAS 突变亚组和对化疗无反应（NRC）亚组，R1 切除的 OS 明显较差（RAS 突变，P=0.002；NRC，P=0.022）。当考虑结合 RAS 和化疗反应状态的肿瘤生物学时，R1 切除仅可接受 RAS 野生型且 RC 的患者（5 年 OS：R0 组为 66.4%，R1 组为 65.2%，P=0.884），但对于 RAS 突变或 NRC 的患者则明显较差。
肿瘤生物学在决定接受根治性手术的 CRLM 患者的适当切除边界方面起着重要作用。R1 切除边界仅可接受 RAS 野生型且对化疗有反应的患者。
