Kurbatov Vadim, Resio Benjamin J, Cama Cara A, Heller Danielle R, Cha Charles, Zhang Yawei, Lu Jun, Khan Sajid A
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Section of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA.
J Gastrointest Oncol. 2020 Feb;11(1):76-83. doi: 10.21037/jgo.2020.01.03.
The only possibility for cure in patients with colon adenocarcinoma (CAC) with isolated liver metastases (ILM) is resection of both primary and metastatic tumors. Little is known about the implication of the sequence in which a colectomy and hepatectomy are performed on outcomes. This study analyzes whether resection sequence impacts clinical outcomes.
The National Cancer Database was queried for CAC cases with hepatic metastases from 2010-2015 with exclusion of extrahepatic metastases. We compared patients treated with a liver-first approach (LFA) to those treated with a colectomy-first or simultaneous approach using Kaplan Meier and multivariable Cox proportional hazards analysis.
In 21,788 CAC patients identified, the LFA was uncommon (2%), but was associated with higher rates of completion resection of remaining tumor (41% . 22%, P<0.001). Patients selected for LFA were younger, less comorbid, and more commonly received upfront chemotherapy (P<0.05). The LFA was associated with increased median survival [34 months, 95% CI (30.5-39.6 months) . 24 months, 95% CI (23.7-24.6 months), logrank P<0.001] and decreased risk of death [HR 0.783; 95% CI (0.67-0.89), P=0.001].
The LFA to CAC with synchronous ILM is uncommon but is associated with greater likelihood of receiving chemotherapy prior to surgery and increased survival in selected candidates.
对于患有孤立性肝转移（ILM）的结肠腺癌（CAC）患者，唯一的治愈可能性是切除原发性和转移性肿瘤。关于结肠切除术和肝切除术的执行顺序对结局的影响知之甚少。本研究分析切除顺序是否会影响临床结局。
查询国家癌症数据库中2010 - 2015年有肝转移的CAC病例，排除肝外转移。我们使用Kaplan Meier和多变量Cox比例风险分析，将采用肝优先方法（LFA）治疗的患者与采用结肠切除术优先或同步方法治疗的患者进行比较。
在21,788例确诊的CAC患者中，LFA并不常见（2%），但与残留肿瘤的完整切除率较高相关（41%对22%，P<0.001）。选择LFA的患者更年轻，合并症更少，且更常接受一线化疗（P<0.05）。LFA与中位生存期延长相关[34个月，95%置信区间（30.5 - 39.6个月）对24个月，95%置信区间（23.7 - 24.6个月），对数秩检验P<0.001]，且死亡风险降低[风险比0.783；95%置信区间（0.67 - 0.89），P = 0.001]。
对于伴有同步ILM的CAC患者，LFA并不常见，但与术前接受化疗的可能性更大以及特定候选患者的生存期延长相关。
