Bonadio Renata Colombo, Amor Divino Paulo Henrique, Obando Jorge Santiago Madero, Lima Karolina Cayres Alvino, Recchimuzzi Débora Zachello, Kruger Jaime Arthur Pirola, Saragiotto Daniel Fernandes, Capareli Fernanda C, Hoff Paulo M
Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.
Oncologia D'or, São Paulo, Brazil.
J Glob Oncol. 2019 Sep;5:1-6. doi: 10.1200/JGO.19.00180.
Conversion chemotherapy is often used for borderline or unresectable (B/U) liver metastases from colorectal cancer (CRC) with the aim of achieving resectability. Although intensive and costly regimens are often used, the best regimen in this scenario remains unclear. We aimed to evaluate the outcomes of patients with B/U liver metastases from CRC treated with conversion chemotherapy with the modified fluorouracil, leucovorin, and oxaliplatin (mFLOX) regimen followed by metastasectomy.
We performed a single-center retrospective analysis of patients with B/U liver metastases from CRC treated with chemotherapy with the mFLOX regimen followed by surgery. B/U disease was defined as at least one of the following: more than four lesions, involvement of hepatic artery or portal vein, or involvement of biliary structure.
Fifty-four consecutive patients who met our criteria for B/U liver metastases were evaluated. Thirty-five patients (64%) had more than four liver lesions, 16 (29%) had key vascular structure involvement, and 16 (29%) had biliary involvement. After chemotherapy, all patients had surgery and 42 (77%) had R0 resection. After a median follow-up of 37.2 months, median progression-free survival (PFS) was 16.9 months and median overall survival (OS) was 68.3 months. R1-R2 resections were associated with worse PFS and OS compared with R0 resection (PFS: hazard ratio, 2.65; = .007; OS: hazard ratio, 2.90; = .014).
Treatment of B/U liver metastases from CRC with conversion chemotherapy using mFLOX regimen followed by surgical resection was associated with a high R0 resection rate and favorable survival outcomes. On the basis of our results, we consider mFLOX a low-cost option for conversion chemotherapy among other options that have been proposed.
转化化疗常用于结直肠癌（CRC）的边缘性或不可切除（B/U）肝转移，目的是实现可切除性。尽管经常使用强化且昂贵的方案，但这种情况下的最佳方案仍不明确。我们旨在评估接受改良氟尿嘧啶、亚叶酸钙和奥沙利铂（mFLOX）方案转化化疗后行肝转移灶切除术的CRC患者B/U肝转移的治疗结果。
我们对接受mFLOX方案化疗后手术的CRC患者B/U肝转移进行了单中心回顾性分析。B/U疾病定义为以下至少一项：超过四个病灶、肝动脉或门静脉受累、或胆道结构受累。
对54例符合我们B/U肝转移标准的连续患者进行了评估。35例患者（64%）有超过四个肝病灶，16例（29%）有关键血管结构受累，16例（29%）有胆道受累。化疗后，所有患者均接受了手术，42例（77%）实现了R0切除。中位随访37.2个月后，中位无进展生存期（PFS）为16.9个月，中位总生存期（OS）为68.3个月。与R0切除相比，R1 - R2切除与更差的PFS和OS相关（PFS：风险比为2.65；P = 0.007；OS：风险比为2.90；P = 0.014）。
采用mFLOX方案进行转化化疗后手术切除治疗CRC的B/U肝转移，R0切除率高，生存结果良好。基于我们的结果，我们认为mFLOX是转化化疗中一种低成本的选择，优于其他已提出的选择。
