Chen Qichen, Li Xingchen, Zhao Jianjun, Bi Xinyu, Li Zhiyu, Huang Zhen, Zhang Yefan, Zhou Jianguo, Zhao Hong, Cai Jianqiang
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2021 Jan;9(1):7. doi: 10.21037/atm-20-4289.
The optimal number of neoadjuvant chemotherapy (NAC) cycles for resectable colorectal liver oligometastases (CLOM) remains unclear. The aim of this study was to investigate the optimal number of NAC cycles.
One hundred twenty-nine consecutive patients were included in this study. X-tile analysis was implemented to investigate the optimal cut-off point for NAC cycles. Propensity score matching was performed to reduce selection bias. Kaplan-Meier curves and Cox risk regression models were used to analyse progression-free survival (PFS) and overall survival (OS).
The optimal cut-off point for NAC cycles was 5. There were no significant differences in R0 resection, pathological response or postoperative complications between the groups with a low number of NAC cycles group (≤5 cycles, n=80) and high number of NAC cycles (>5 cycles, n=49). Patients with a high number of NAC cycles were more likely to have NAC toxicity than those with a low number of cycles (87.8% 65.0%, P=0.004). Multivariate analysis revealed that >5 NAC cycles was an independent predictor of reduced PFS (HR =1.808, 95% CI: 1.205-2.712, P=0.004) and reduced OS (HR =1.723, 95% CI: 1.041-2.851, P=0.034). In the oxaliplatin-based regimen group, patients with a low number of NAC cycles had a better PFS (P<0.001, mPFS: 14.7 5.4 months) and better OS (P=0.018, mOS: 57.7 months 41.0 months) than those with a high number of cycles. After 1:1 propensity matching (34 cases 34 cases), multivariate analysis revealed that >5 NAC cycles was an independent predictor of reduced PFS (HR =2.265, 95% CI: 1.281-4.007, P=0.005) and reduced OS (HR =2.813, 95% CI: 1.359-5.822, P=0.005). In the oxaliplatin-based regimen group, patients with a low number of NAC cycles had better PFS (P<0.001, mPFS: 17.5 5.6 months) and better OS (P=0.008, mOS: 59.0 31.8 months) than those with a high number of cycles.
Fewer than 5 NAC cycles was optimal for biologically resectable CLOM patients. Giving more than 5 NAC cycles was unnecessary because a higher number of NAC cycles has more unfavourable survival and higher NAC toxicities, while leading to similar R0 resection rates and pathological responses.
可切除的结直肠癌肝寡转移（CLOM）患者新辅助化疗（NAC）的最佳周期数仍不明确。本研究旨在探讨NAC的最佳周期数。
本研究纳入了129例连续的患者。采用X-tile分析来研究NAC周期的最佳截断点。进行倾向评分匹配以减少选择偏倚。采用Kaplan-Meier曲线和Cox风险回归模型分析无进展生存期（PFS）和总生存期（OS）。
NAC周期的最佳截断点为5。NAC周期数少的组（≤5个周期，n = 80）和NAC周期数多的组（>5个周期，n = 49）在R0切除、病理反应或术后并发症方面无显著差异。NAC周期数多的患者比周期数少的患者更易出现NAC毒性（87.8%对65.0%，P = 0.004）。多因素分析显示，>5个NAC周期是PFS降低（HR = 1.808，95%CI：1.205 - 2.712，P = 0.004）和OS降低（HR = 1.723，95%CI：1.041 - 2.851，P = 0.034）的独立预测因素。在基于奥沙利铂的方案组中，NAC周期数少的患者比周期数多的患者有更好的PFS（P < 0.001，中位PFS：14.7对5.4个月）和更好的OS（P = 0.018，中位OS：57.7个月对41.0个月）。在1:1倾向匹配（34例对34例）后，多因素分析显示，>5个NAC周期是PFS降低（HR = 2.265，95%CI：1.281 - 4.007，P = 0.005）和OS降低（HR = 2.813，95%CI：1.359 - 5.822，P = 0.005）的独立预测因素。在基于奥沙利铂的方案组中，NAC周期数少的患者比周期数多的患者有更好的PFS（P < 0.001，中位PFS：17.5对5.6个月）和更好的OS（P = 0.008，中位OS：59.0对31.8个月）。
对于生物学上可切除的CLOM患者，少于5个NAC周期是最佳的。给予超过5个NAC周期是不必要的，因为更多的NAC周期会导致更不利的生存和更高的NAC毒性，同时R0切除率和病理反应相似。
