Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Ann Surg Oncol. 2021 Aug;28(8):4744-4755. doi: 10.1245/s10434-020-09449-8. Epub 2021 Jan 3.
The optimal perioperative management of patients who undergo hepatectomy for resectable colorectal liver metastases (CRLM) remains unclear due to the lack of reliable methods to stratify the risk of recurrence.
A single-center retrospective study was performed to investigate the impact of preoperative circulating tumor DNA (ctDNA) on survival outcomes of patients who underwent initial hepatectomy for solitary resectable CRLM between January 2005 and December 2017 using the comprehensive genotyping platform Guardant360.
Of 212 patients who underwent initial hepatectomy for solitary resectable CRLM, 40 patients for whom pre-hepatectomy plasma was available underwent ctDNA analysis. Among them, 32 (80%) had at least 1 somatic alteration in their ctDNA, while the other 8 (20%) had no detectable ctDNA. Among the patients with undetectable ctDNA, only one had recurrence and none died during a median follow-up period of 39.0 months. The recurrence-free survival was significantly shorter in patients who were positive for ctDNA than in those who were negative for ctDNA [median, 12.5 months vs not reached (NR); HR, 7.6; P = 0.02]. The overall survival also tended to be shorter in patients who were positive for ctDNA than those who were negative for ctDNA (median, 78.1 months vs NR; P = 0.14; HR not available).
In patients undergoing hepatectomy for solitary resectable CRLM, the absence of detectable preoperative ctDNA identified patients with a high chance for a cure. Risk stratification according to preoperative ctDNA analysis may be an effective tool that can improve the perioperative management of these patients.
由于缺乏可靠的方法来分层复发风险，接受可切除结直肠癌肝转移（CRLM）切除术的患者的最佳围手术期管理仍不明确。
对 2005 年 1 月至 2017 年 12 月期间接受初始肝切除术治疗单发可切除 CRLM 的患者进行了单中心回顾性研究，使用全面基因分型平台 Guardant360 研究术前循环肿瘤 DNA（ctDNA）对患者生存结果的影响。
在 212 例接受初始肝切除术治疗单发可切除 CRLM 的患者中，有 40 例患者在肝切除术前有血浆可供进行 ctDNA 分析。其中，32 例（80%）ctDNA 至少有 1 个体细胞改变，而另外 8 例（20%）ctDNA 未检出。在 ctDNA 未检出的患者中，仅有 1 例复发，中位随访 39.0 个月时无死亡。ctDNA 阳性患者的无复发生存明显短于 ctDNA 阴性患者[中位时间，12.5 个月 vs 未达到（NR）；HR，7.6；P=0.02]。ctDNA 阳性患者的总生存也明显短于 ctDNA 阴性患者（中位时间，78.1 个月 vs NR；P=0.14；HR 无法获得）。
在接受肝切除术治疗单发可切除 CRLM 的患者中，术前未检出可检测的 ctDNA 可识别出有很大治愈机会的患者。根据术前 ctDNA 分析进行风险分层可能是一种有效的工具，可以改善这些患者的围手术期管理。
