Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2019 Sep;229(3):286-294.e1. doi: 10.1016/j.jamcollsurg.2019.04.027. Epub 2019 May 2.
BACKGROUND: Conditional recurrence-free survival (RFS) probability, that is, the probability of remaining recurrence-free after a given interval without recurrence, has not been reported after resection of colorectal liver metastases (CLMs). We aimed to estimate conditional RFS and identify factors affecting conditional RFS. STUDY DESIGN: Patients undergoing initial resection of CLMs during 2000-2016 with mutation data were identified. The RFS and risk factors for recurrence were evaluated at the time of resection for all patients and at 1 year and 2 years after resection for patients who remained recurrence-free. RESULTS: Of 2,118 patients, 485 met the inclusion criteria, of which 225 were recurrence-free at 1 year and 109 were recurrence-free at 2 years. The 5-year RFS rates were 17.3%, 36.8%, and 70.7% for all patients and the 1-year and 2-year recurrence-free groups, respectively, when assessed from the time of initial CLM resection. RAS/TP53 co-mutation was the only factor independently associated with increased risk of recurrence for all groups (all patients, hazard ratio 1.47; 95% CI 1.19 to 1.82; p < 0.001; 1-year recurrence-free, hazard ratio 1.69; 95% CI 1.17 to 2.43; p = 0.005; 2-year recurrence-free, hazard ratio 2.41; 95% CI 1.12 to 5.17; p = 0.024). T category, extrahepatic disease, multiple CLMs, largest CLM diameter, and surgical margin status were risk factors for recurrence in all patients and/or the 1-year recurrence-free group, but not the 2-year recurrence-free group. Median RFS was lower for patients with RAS/TP53 co-mutation than for those with RAS/TP53 wild-type in the 1-year (1.5 vs 2.8 years; p = 0.006) and 2-year recurrence-free groups (3.0 vs 5.9 years; p = 0.024). CONCLUSIONS: Conditional RFS is useful for updating prognosis after a given time interval without recurrence after CLM resection. Importantly, RAS/TP53 co-mutation has a persistent deleterious association with recurrence.
背景:在结直肠肝转移瘤(CLM)切除术后,尚未报道有条件无复发生存率(RFS),即给定时间间隔内无复发的生存概率。我们旨在评估有条件的 RFS 并确定影响有条件 RFS 的因素。
研究设计:确定了 2000-2016 年间接受初始 CLM 切除术且有突变数据的患者。对所有患者在切除时以及在无复发的患者在切除后 1 年和 2 年时评估 RFS 和复发风险因素。
结果:在 2118 名患者中,有 485 名符合纳入标准,其中 225 名在 1 年内无复发,109 名在 2 年内无复发。所有患者、1 年无复发组和 2 年无复发组的 5 年 RFS 率分别为 17.3%、36.8%和 70.7%,从初始 CLM 切除时开始评估。RAS/TP53 共突变是所有组中唯一与复发风险增加相关的因素(所有患者,风险比 1.47;95%CI 1.19 至 1.82;p<0.001;1 年无复发,风险比 1.69;95%CI 1.17 至 2.43;p=0.005;2 年无复发,风险比 2.41;95%CI 1.12 至 5.17;p=0.024)。T 分期、肝外疾病、多个 CLM、最大 CLM 直径和手术切缘状态是所有患者和/或 1 年无复发组的复发风险因素,但不是 2 年无复发组的复发风险因素。在 1 年(1.5 年与 2.8 年;p=0.006)和 2 年无复发组(3.0 年与 5.9 年;p=0.024)中,RAS/TP53 共突变患者的中位 RFS 低于 RAS/TP53 野生型患者。
结论:在 CLM 切除术后无复发的特定时间间隔后,有条件的 RFS 有助于更新预后。重要的是,RAS/TP53 共突变与复发具有持续的有害关联。
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