Ichikawa Nobuki, Kamiyama Toshiya, Yokoo Hideki, Homma Shigenori, Maeda Yoshiaki, Shinohara Toshiki, Tsuruga Yosuke, Kazui Keizo, Iijima Hiroaki, Yoshida Tadashi, Taketomi Akinobu
Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan.
Department of Gastroenterological Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido 003-0804, Japan.
Mol Clin Oncol. 2020 Apr;12(4):374-383. doi: 10.3892/mco.2020.1992. Epub 2020 Jan 30.
The response to preoperative chemotherapy is useful for predicting prognosis in unresectable and resectable disease. However, the prognostic benefit of chemotherapy prior to hepatectomy in patients with colorectal carcinoma and resectable or marginally resectable liver metastases remains unclear. The present study investigated the effect of preoperative chemotherapy on the prognosis of patients with colorectal cancer and resectable or marginally resectable synchronous liver metastasis. A total of 106 patients were retrospectively reviewed, who underwent hepatectomy for colorectal metastasis. The prognosis of 64 patients who received neoadjuvant chemotherapy (NAC) were compared with the 42 patients who did not (non-NAC). Furthermore, a total of 43 patients who responded to chemotherapy were compared with the 21 who did not. Preoperative chemotherapy was administered for 5.7 months, wherein 50 patients (78%) received a single regimen, and 54 (84%) received oxaliplatin. There were more patients with <3 metastases and maximum diameters <5 cm in the non-NAC group. The median survival time was 86.0 and 71.6 months in the NAC and non-NAC groups, respectively (P=0.33). Subgroup analysis on the basis of tumor size and number showed no prognostic differences between the two groups. The median survival time was longer in responders than in non-responders (85 vs. 56 months; P=0.01). However, the median relapse-free survival was equivalent in both groups (16.4 and 10.7 months). Preoperative chemotherapy did not prolong survival. Furthermore, it did not prevent recurrence, even in clinical responders. Therefore, it should not be routinely offered to patients with resectable liver metastasis before their hepatectomy.
术前化疗的反应对于预测不可切除和可切除疾病的预后是有用的。然而，在患有结直肠癌且肝转移灶可切除或接近可切除的患者中，肝切除术前化疗的预后益处仍不明确。本研究调查了术前化疗对患有结直肠癌且肝转移灶可切除或接近可切除的同步肝转移患者预后的影响。对总共106例行肝切除治疗结直肠癌转移的患者进行了回顾性研究。将64例接受新辅助化疗（NAC）的患者的预后与42例未接受新辅助化疗（非NAC）的患者进行比较。此外，将43例化疗有反应的患者与21例无反应的患者进行比较。术前化疗进行了5.7个月，其中50例患者（78%）接受单一方案，54例患者（84%）接受奥沙利铂治疗。非NAC组中转移灶<3个且最大直径<5 cm的患者更多。NAC组和非NAC组的中位生存时间分别为86.0个月和71.6个月（P=0.33）。基于肿瘤大小和数量的亚组分析显示两组之间无预后差异。有反应者的中位生存时间长于无反应者（85个月对56个月；P=0.01）。然而，两组的无复发生存期中位数相当（16.4个月和10.7个月）。术前化疗并未延长生存期。此外，即使在临床有反应者中，它也不能预防复发。因此，对于肝转移灶可切除的患者，在肝切除术前不应常规给予术前化疗。
