Du Pasquier Céline, Roulin Didier, Bize Pierre, Sempoux Christine, Rebecchini Caterina, Montemurro Michael, Schäfer Markus, Halkic Nermin, Demartines Nicolas
Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Department of Pathology, Lausanne University Hospital (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
BMC Surg. 2020 Apr 19;20(1):78. doi: 10.1186/s12893-020-00738-3.
The reverse treatment of patients with synchronous colorectal liver metastases (CRLM) is a sequential approach with systemic chemotherapy first, followed by liver resection, and finally, primary tumor resection. The aim of this study was to assess the feasibility, the radiological and pathological tumor response to neoadjuvant therapy, recurrence rates and long-term survival after reverse treatment in a cohort study.
Data from patients with CRLM who underwent a reverse treatment from August 2008 to October 2016 were extracted from our prospective hepato-biliary database and retrospectively analyzed for response rates and survival outcomes. Radiological tumor response was assessed by RECIST (Response Evaluation Criteria In Solid Tumor) criteria and pathological response according to TRG (Tumor Regression Grade). Disease-free and overall survival were estimated with Kaplan-Meier survival curves.
There were 44 patients with 19 rectal and 25 colonic tumors. The reverse treatment was fully completed until primary tumor resection in 41 patients (93%). Radiological assessment after chemotherapy showed 61% of complete/partial response. Pathological tumor response was major or partial in 52% of patients (TRG 1-3). Median disease-free survival after primary tumor resection was 10 months (95% CI 5-15 months). Disease-free survival at 3 and 5 years was 25% and 25%, respectively. Median overall survival was 50 months (95% CI 42-58 months). Overall survival at 3 and 5 years was 59% and 39%, respectively.
The reverse treatment approach was feasible with a high rate of patients with complete treatment sequence and offers promising long-term survival for selected patients with advanced simultaneous colorectal liver metastases.
同步性结直肠癌肝转移（CRLM）患者的反向治疗是一种序贯治疗方法，首先进行全身化疗，其次是肝切除，最后进行原发肿瘤切除。本研究的目的是在一项队列研究中评估反向治疗的可行性、新辅助治疗的放射学和病理学肿瘤反应、复发率及长期生存率。
从我们前瞻性的肝胆数据库中提取2008年8月至2016年10月接受反向治疗的CRLM患者的数据，并对反应率和生存结果进行回顾性分析。根据实体瘤疗效评价标准（RECIST）评估放射学肿瘤反应，根据肿瘤退缩分级（TRG）评估病理学反应。采用Kaplan-Meier生存曲线估计无病生存期和总生存期。
44例患者，其中19例为直肠肿瘤，25例为结肠肿瘤。41例患者（93%）完成了直至原发肿瘤切除的完整反向治疗。化疗后的放射学评估显示61%为完全/部分缓解。52%的患者病理学肿瘤反应为主要或部分反应（TRG 1-3）。原发肿瘤切除后的中位无病生存期为10个月（95%可信区间5-15个月）。3年和5年的无病生存率分别为25%和25%。中位总生存期为50个月（95%可信区间42-58个月）。3年和5年的总生存率分别为59%和39%。
反向治疗方法可行，完整治疗序列的患者比例较高，为部分晚期同步性结直肠癌肝转移患者提供了有前景的长期生存。
