一线治疗期间结直肠癌肝转移患者集中重复可切除性评估：前瞻性研究。
Centralized repeated resectability assessment of patients with colorectal liver metastases during first-line treatment: prospective study.
机构信息
Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Radiology, Helsinki University Hospital, Päijät-Häme Central Hospital, Lahti, Finland.
出版信息
Br J Surg. 2021 Jul 23;108(7):817-825. doi: 10.1093/bjs/znaa145.
BACKGROUND
Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases.
METHODS
The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival.
RESULTS
Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0-1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0-1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively.
CONCLUSION
Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.
背景
转移性结直肠癌中可能较少进行转移灶切除术。本研究旨在探讨集中重复评估对肝转移灶可切除性的影响。
方法
前瞻性 RAXO 研究是芬兰的一项全国性研究。任何部位有可治疗转移性结直肠癌的患者符合条件。本计划亚研究包括 2012 年至 2018 年间基线时有肝转移的患者。在赫尔辛基三级转诊中心，由多学科团队对可切除性进行初步评估，并在一线系统治疗期间进行两次评估。结果为可切除性率、治疗改变和生存。
结果
在 812 名入组患者中，301 名（37.1%）有单纯肝转移。这些患者中，161 名（53.5%）肿瘤为初始可切除，63 名（20.9%）在系统治疗期间可手术。207 名（68.7%）患者最终接受了肝切除术或消融术。基线时，中央评估与局部判断之间的可切除性存在差异，有 102 名患者（33.9%）。首次切除后的无病生存（DFS）中位数为 20 个月，总生存（OS）中位数为 79 个月。诊断为转移性结直肠癌后，RO-1 切除、R2/消融和未切除组的中位 OS 分别为 80、32 和 21 个月，5 年 OS 率分别为 68%、37%和 9%。511 名患者存在肝内和肝外转移。这些患者中，72 名（14.1%）肿瘤为初始可切除，53 名（10.4%）有手术机会。最终，110 名（21.5%）患者接受了肝切除术或消融术。基线时，局部和中央可切除性存在差异的患者有 116 名（22.7%）。首次切除后的 DFS 中位数为 7 个月，OS 中位数为 55 个月。诊断为转移性结直肠癌后，RO-1 切除、R2/消融和未切除组的中位 OS 分别为 79、42 和 17 个月，5 年 OS 率分别为 65%、39%和 2%。
结论
对结直肠癌肝转移患者进行重复集中评估可提高切除率和生存率。
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