Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
Ann Surg. 2022 Aug 1;276(2):357-362. doi: 10.1097/SLA.0000000000004672. Epub 2020 Dec 18.
To determine if tumor genetics are associated with overall survival (OS) after concurrent resection of colorectal liver metastases (CLM) and extrahepatic disease (EHD).
The prognosis for patients who undergo concurrent resection of CLM/EHD is unclear and the impact of somatic mutations has not been reported.
Patients undergoing concurrent resection of CLM and EHD from 2007 to 2017 were identified from 2 academic centers. From 1 center, patients were selected from a pre-existing database of patients undergoing cytore-ductive surgery with hyperthermic intraperitoneal chemotherapy. The Kaplan-Meier method was used to construct survival curves, compared using the log-rank test. Multivariable Cox analysis for OS was performed.
One hundred nine patients were included. Most common EHD sites included lung (33 patients), peritoneum (32), and portal lymph nodes (14). TP53 mutation was the most common mutation, identified in 75 patients (69%), and RAS/TP53 co-mutation was identified in 31 patients (28%). The median OS was 49 months (interquartile range, 24-125), and 3- and 5-year OS rates were 66% and 44%, respectively. Compared to patients without RAS/ TP53 co-mutation, patients with RAS/TP53 co-mutation had lower median OS: 39 vs. 51 months ( P = 0.02). On multivariable analysis, lung EHD [hazard ratio (HR), 0.7; 95% confidence intervals (CI), 0.3-1.4], peritoneal EHD (HR, 2.2; 95% CI, 1.1-4.2) and RAS/TP53 co-mutation (HR, 2.8; 95% CI, 1.1-7.2) were independently associated with OS.
RAS/TP53 co-mutation is associated with worse OS after concurrent CLM/EHD resection. Mutational status and site of EHD should be included in the evaluation of patients considered for concurrent resection.
确定肿瘤遗传学是否与结直肠肝转移（CLM）和肝外疾病（EHD）同期切除后的总生存期（OS）相关。
同时切除 CLM/EHD 的患者预后尚不清楚，体细胞突变的影响尚未报道。
从 2 个学术中心确定了 2007 年至 2017 年同期切除 CLM 和 EHD 的患者。从 1 个中心，患者是从接受细胞减灭术和腹腔热灌注化疗的患者的现有数据库中选择的。使用 Kaplan-Meier 方法构建生存曲线，并用对数秩检验进行比较。对 OS 进行多变量 Cox 分析。
共纳入 109 例患者。最常见的 EHD 部位包括肺（33 例）、腹膜（32 例）和门静脉淋巴结（14 例）。75 例（69%）患者存在 TP53 突变，31 例（28%）患者存在 RAS/TP53 共突变。中位 OS 为 49 个月（四分位距，24-125），3 年和 5 年 OS 率分别为 66%和 44%。与无 RAS/TP53 共突变的患者相比，有 RAS/TP53 共突变的患者中位 OS 更短：39 与 51 个月（P=0.02）。多变量分析显示，肺 EHD[风险比（HR），0.7；95%置信区间（CI），0.3-1.4]、腹膜 EHD（HR，2.2；95%CI，1.1-4.2）和 RAS/TP53 共突变（HR，2.8；95%CI，1.1-7.2）与 OS 独立相关。
RAS/TP53 共突变与 CLM/EHD 同期切除后 OS 较差相关。在考虑同期切除的患者评估中，应包括突变状态和 EHD 部位。
