Brouquet Antoine, Blot Christelle, Allard Marc-Antoine, Lazure Thierry, Sebbagh Mylène, Gayet Mathilde, Lewin Maïté, Adam René, Penna Christophe, Sa Cunha Antonio, Benoist Stephane
Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Sud, Le Kremlin Bicêtre, France.
Paris-Sud University, Le Kremlin Bicêtre, France.
Ann Surg Oncol. 2020 Aug;27(8):2877-2885. doi: 10.1245/s10434-020-08284-1. Epub 2020 Mar 6.
The clinical significance of discordant radiological and pathological response to preoperative chemotherapy of colorectal liver metastases (CLM) is unknown.
From 2011 to 2016, all eligible patients undergoing resection for CLM after preoperative chemotherapy were included at two centres. Patients were categorized according to radiologic response using RECIST as Rad-responders (complete/partial response) or Rad-non responders (stable disease) and according to Blazer et al. pathologic response grade as Path-responders (complete/major response) or Path-non responders (minor response). Survival outcome was analysed according to radiologic and pathologic response.
Among 413 patients undergoing resection of CLM, 119 fulfilled the inclusion criteria. Among these, 52 (44%) had discordant radiologic and pathologic response including 27 Rad-non responders/path responders and 25 Rad-responders/Path-non responders. Rad-non responders/path responders and Rad-responders/Path-non responders had similar characteristics except for the proportion receiving more than 6 cycles of preoperative chemotherapy (7/27 vs 16/25; P = 0.017). Median disease-free survival was not different in patients with or without discordant radiologic and pathologic responses (P = 0.195) but the type of discordance had an impact on oncologic outcome as median disease-free survival was 13.9 months (95% CI 5.7-22.2 months) in Rad-non responders/Path responders and 8.6 (6.2 - 10.9 months) in Rad-responders/Path-non responders (P = 0.034). Univariate and multivariate analysis showed that major pathologic response was associated with improved disease-free survival (OR 0.583, 95% CI 0.36-0.95, P = 0.031).
A discordant radiologic and pathologic response is common after preoperative chemotherapy for CLM. In these patients, pathologic response drives oncologic outcome.
结直肠癌肝转移（CLM）术前化疗的放射学反应与病理学反应不一致的临床意义尚不清楚。
2011年至2016年，两个中心纳入了所有术前化疗后接受CLM切除术的符合条件的患者。根据使用RECIST的放射学反应将患者分类为放射学反应者（完全/部分缓解）或放射学无反应者（疾病稳定），并根据布莱泽等人的病理学反应分级分类为病理学反应者（完全/主要缓解）或病理学无反应者（次要缓解）。根据放射学和病理学反应分析生存结果。
在413例接受CLM切除术的患者中，119例符合纳入标准。其中，52例（44%）的放射学反应与病理学反应不一致，包括27例放射学无反应者/病理学反应者和25例放射学反应者/病理学无反应者。放射学无反应者/病理学反应者和放射学反应者/病理学无反应者具有相似的特征，但接受超过6周期术前化疗的比例除外（7/27对16/25；P = 0.017）。有或无放射学和病理学反应不一致的患者的无病生存期无差异（P = 0.195），但不一致的类型对肿瘤学结局有影响，因为放射学无反应者/病理学反应者的无病生存期为13.9个月（95%CI 5.7 - 22.2个月），而放射学反应者/病理学无反应者为8.6个月（6.2 - 10.9个月）（P = 0.034）。单因素和多因素分析表明，主要病理学反应与改善的无病生存期相关（OR 0.583，95%CI 0.36 - 0.95，P = 0.031）。
CLM术前化疗后放射学反应与病理学反应不一致很常见。在这些患者中，病理学反应决定肿瘤学结局。
Zotero 插件