Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; U1071 Inserm/Clermont-Auvergne University, Clermont-Ferrand, France.
HPB (Oxford). 2021 Apr;23(4):601-608. doi: 10.1016/j.hpb.2020.08.018. Epub 2020 Sep 14.
The utility of adjuvant chemotherapy after resection of colorectal liver metastasis (CLM) in patients with rapid recurrence after adjuvant chemotherapy for their primary tumor is unclear. The aim of this study was to evaluate the oncologic benefit of adjuvant hepatic arterial plus systemic chemotherapy (HAIC + Sys) in patients with early CLM.
A retrospective analysis of patients with early CLM (≤12 months of adjuvant chemotherapy for primary tumor) who received either HAIC + Sys, adjuvant systemic chemotherapy alone (Sys), or active surveillance (Surgery alone) following resection of CLM was performed. Recurrence and survival were compared between treatment groups using Kaplan-Meier methods and Cox proportional hazards models.
Of 239 patients undergoing resection of early CLM, 79 (33.1%) received HAIC + Sys, 77 (32.2%) received Sys, and 83 (34.7%) had Surgery alone. HAIC + Sys was independently associated with reduced risk of RFS events (adjusted hazard ratio [HRadj]: 0.64, 95%CI:0.44-0.94, p = 0.022) and all-cause mortality (HRadj: 0.54, 95%CI:0.36-0.81, p = 0.003) compared to Surgery alone patients. Largest tumor >5 cm (HRadj: 2.03, 95%CI: 1.41-2.93, p < 0.001) and right-sided colon tumors (HRadj: 1.93, 95%CI: 1.29-2.89, p = 0.002) were independently associated with worse OS.
Adjuvant HAIC + Sys after resection of early CLM that occur after chemotherapy for node-positive primary is associated with improved outcomes.
对于辅助化疗后原发肿瘤快速复发的结直肠癌肝转移（CLM）患者，辅助化疗后切除的辅助化疗的效用尚不清楚。本研究旨在评估辅助肝动脉加全身化疗（HAIC+Sys）在早期 CLM 患者中的肿瘤学获益。
对接受 HAIC+Sys、辅助全身化疗（Sys）或主动监测（仅手术）治疗的 CLM 切除后早期 CLM（≤12 个月的辅助化疗用于原发性肿瘤）患者进行回顾性分析。采用 Kaplan-Meier 方法和 Cox 比例风险模型比较治疗组之间的复发和生存情况。
在 239 例接受早期 CLM 切除术的患者中，79 例（33.1%）接受了 HAIC+Sys 治疗，77 例（32.2%）接受了 Sys 治疗，83 例（34.7%）接受了单独手术治疗。与单独手术治疗患者相比，HAIC+Sys 可独立降低 RFS 事件的风险（调整后的风险比[HRadj]：0.64，95%CI：0.44-0.94，p=0.022）和全因死亡率（HRadj：0.54，95%CI：0.36-0.81，p=0.003）。最大肿瘤>5cm（HRadj：2.03，95%CI：1.41-2.93，p<0.001）和右半结肠癌（HRadj：1.93，95%CI：1.29-2.89，p=0.002）与 OS 较差独立相关。
CLM 切除术后，辅助化疗后出现淋巴结阳性原发肿瘤的早期 CLM 患者接受辅助 HAIC+Sys 治疗可改善预后。
