Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro-173-beon-gil, Seongnam, 13620, Republic of Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
J Cancer Res Clin Oncol. 2020 Sep;146(9):2399-2410. doi: 10.1007/s00432-020-03233-7. Epub 2020 May 1.
Some metastatic colorectal cancer (mCRC) patients receive conversion surgery (CS), including metastasectomy after palliative chemotherapy. Although targeted agents significantly improved the outcomes, the clinical outcome of CS in the targeted agent era has not yet been thoroughly investigated.
We analyzed the clinical data of 96 mCRC patients who initially had unresectable liver- and/or lung-limited metastases and underwent first-line cetuximab or bevacizumab plus FOLFIRI between January 2013 and June 2017.
Liver-limited metastasis was seen in 44 patients (45.8%), lung-limited metastases in 21 patients (21.9%), and both liver and lung metastases in 31 patients (32.3%). Among them, 37 patients (38.5%) received cetuximab, and 59 patients (61.5%) received bevacizumab plus FOLFIRI. Overall response rate was 63.9% and 40.7%, respectively (p = 0.035). After median 8.7 (range 2.5-27.3) months, CS was performed in 11 patients (29.7%) in cetuximab group and 15 patients (25.4%) in bevacizumab group (p = 0.646). Median overall survival has not been reached in R0-resected patients (n = 23), during the median follow-up period of 22.5 (range 9.8-54.5) months. Median disease-free survival was 7.1 (95% CI 2.5-11.7) months: 11.0 (95% CI 3.1-19.0) months in cetuximab group and 3.2 (95% CI 0.0-7.8) months in bevacizumab group (p = 0.422). There was no progression after 18.5 months and disease-free survival reached a plateau at 19.9%.
A substantial proportion of patients could receive CS after cetuximab or bevacizumab plus FOLFIRI chemotherapy. R0-resected patients had excellent overall survival, although 80.1% of them eventually experienced recurrence. Some patients could achieve durable disease-free state.
一些转移性结直肠癌（mCRC）患者接受转化手术（CS），包括姑息化疗后进行转移灶切除术。尽管靶向药物显著改善了预后，但靶向药物时代 CS 的临床结果尚未得到充分研究。
我们分析了 96 例 mCRC 患者的临床资料，这些患者最初均存在不可切除的肝和/或肺转移灶，并于 2013 年 1 月至 2017 年 6 月期间接受了一线西妥昔单抗或贝伐珠单抗联合 FOLFIRI 治疗。
44 例（45.8%）患者为肝转移，21 例（21.9%）为肺转移，31 例（32.3%）为肝肺同时转移。其中，37 例（38.5%）接受了西妥昔单抗治疗，59 例（61.5%）接受了贝伐珠单抗联合 FOLFIRI 治疗。总体缓解率分别为 63.9%和 40.7%（p=0.035）。中位随访 8.7 个月（范围 2.5-27.3）后，西妥昔单抗组有 11 例（29.7%）和贝伐珠单抗组有 15 例（25.4%）患者接受了 CS（p=0.646）。在 R0 切除的患者（n=23）中，中位总生存期未达到，在中位 22.5 个月（范围 9.8-54.5）的随访期间。中位无疾病生存期为 7.1 个月（95%CI 2.5-11.7）：西妥昔单抗组为 11.0 个月（95%CI 3.1-19.0），贝伐珠单抗组为 3.2 个月（95%CI 0.0-7.8）（p=0.422）。在 18.5 个月后无进展，无疾病生存期达到 19.9%的平台期。
在接受西妥昔单抗或贝伐珠单抗联合 FOLFIRI 化疗后，相当一部分患者可以接受 CS。R0 切除的患者有极好的总生存期，尽管其中 80.1%的患者最终出现复发。一些患者可以获得持久的无疾病状态。
