Hasselgren Kristina, Isaksson Bengt, Ardnor Bjarne, Lindell Gert, Rizell Magnus, Strömberg Cecilia, Loftås Per, Björnsson Bergthor, Sandström Per
Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Ann Transl Med. 2020 Feb;8(4):109. doi: 10.21037/atm.2019.12.125.
Liver metastases are the most common cause of death for patients with colorectal cancer and affect up to half of the patients. Liver resection is an established method that can potentially be curative. For patients with extrahepatic disease (EHD), the role of liver surgery is less established.
This is a retrospective study based on data from the national quality registry SweLiv. Data were obtained between 2009 and 2015. SweLiv is a validated registry and has been in use since 2009, with coverage above 95%. Patients with liver metastases and EHD were analyzed and cross-checked against the national death cause registry for survival analysis.
During the study period, 2,174 patients underwent surgery for colorectal liver metastases (CRLM), and 277 patients with EHD were treated with resection or ablation. The estimated median survival time for the entire cohort from liver resection/ablation was 40 months (95% CI, 32-47). The survival time for patients treated with liver resection was 45 months compared to 26 months for patients treated with ablation (95% CI 38-53, 18-33, P=0.001). A subgroup analysis of resected patients revealed that the group with pulmonary metastases had a significantly longer estimated median survival (50 months; 95% CI, 39-60) than the group with lymph node metastases (32 months; 95% CI, 7-58) or peritoneal carcinomatosis (28 months; 95% CI, 14-41) (P=0.022 and 0.012, respectively). Other negative prognostic factors were major liver resection and nonradical liver resection.
For patients with liver metastases and limited EHD, liver resection results in prolonged survival compared to what can be expected from chemotherapy alone.
肝转移是结直肠癌患者最常见的死亡原因，多达半数的患者会受到影响。肝切除术是一种既定的、有可能治愈的方法。对于伴有肝外疾病（EHD）的患者，肝手术的作用尚不明确。
这是一项基于瑞典国家肝脏质量登记系统（SweLiv）数据的回顾性研究。数据收集时间为2009年至2015年。SweLiv是一个经过验证的登记系统，自2009年起投入使用，覆盖率超过95%。对伴有肝转移和EHD的患者进行分析，并与国家死因登记系统进行交叉核对以进行生存分析。
在研究期间，2174例患者接受了结直肠癌肝转移（CRLM）手术，277例伴有EHD的患者接受了切除或消融治疗。整个队列从肝切除/消融后的估计中位生存时间为40个月（95%CI，32 - 47）。接受肝切除患者的生存时间为45个月，而接受消融治疗患者的生存时间为26个月（95%CI 38 - 53，18 - 33，P = 0.001）。对切除患者的亚组分析显示，肺转移组的估计中位生存时间（50个月；95%CI，39 - 60）明显长于淋巴结转移组（32个月；95%CI，7 - 58）或腹膜癌转移组（28个月；95%CI，14 - 41）（P分别为0.022和0.012）。其他不良预后因素包括大范围肝切除和非根治性肝切除。
对于伴有肝转移和局限性EHD的患者，与单纯化疗相比，肝切除术可延长生存期。
