Ma Rui, Li Tao
Department of Critical Medicine, Peking University People's Hospital No. 11 Xizhimen South Street, West District, Beijing 100044, P. R. China.
Department of Hepatobiliary Surgery, Peking University People's Hospital No. 11 Xizhimen South Street, West District, Beijing 100044, P. R. China.
Int J Clin Exp Pathol. 2021 Mar 1;14(3):314-321. eCollection 2021.
To explore surgical treatment strategies for patients with liver metastases from colorectal cancer (CRLM), and analyze the prognosis and influencing factors.
The clinical data of 156 inpatients with CRLM admitted to our hospital from January 2009 to June 2019 were retrospectively analyzed. Patients were divided into initially resectable group (80 cases) and initially unresectable group (76 cases). For patients with initially unresectable CRLM, conversion therapy (chemotherapy plus targeted therapy) combined with individualized surgical treatment strategy was used. The individualized surgical treatment strategy mainly included hepatectomy combined with ablation. Portal vein ligation and staged resection were adopted according to the patients' specific conditions. All patients were followed up until death. The Kaplan-Meier method and Log-rank test were used for survival analysis.
Median overall survival (OS) time of patients in the initially resectable group and initially unresectable group were 36 months and 17 months, respectively ( = 0.001). Median OS time of 24 patients who underwent surgical resection after successful conversion therapy was significantly longer than that of 52 patients with unsuccessful conversion therapy (20 months versus 15 months, respectively, = 0.034). Univariate analysis showed that a maximum diameter of liver metastases < 6 cm and a number of metastases ≤ 4 were independent factors associated with successful conversion therapy. According to patients' specific conditions, 6 cases accepted hepatectomy combined with ablation, and 1 case accepted portal vein ligation and staged resection.
Treatment of patients with CRLM should follow the principles of standardization and individualization. For patients with initially unresectable CRLM, successful conversion therapy should be pursued whenever possible. The maximum size and number of liver metastases were significantly associated with successful conversion therapy. Surgical resection-based comprehensive treatment is key.
探讨结直肠癌肝转移（CRLM）患者的外科治疗策略，并分析其预后及影响因素。
回顾性分析2009年1月至2019年6月我院收治的156例CRLM住院患者的临床资料。患者分为初始可切除组（80例）和初始不可切除组（76例）。对于初始不可切除的CRLM患者，采用转化治疗（化疗联合靶向治疗）并结合个体化手术治疗策略。个体化手术治疗策略主要包括肝切除联合消融。根据患者具体情况采用门静脉结扎分期切除。所有患者随访至死亡。采用Kaplan-Meier法和Log-rank检验进行生存分析。
初始可切除组和初始不可切除组患者的中位总生存（OS）时间分别为36个月和17个月（ = 0.001）。24例转化治疗成功后接受手术切除患者的中位OS时间显著长于52例转化治疗失败患者（分别为20个月和15个月， = 0.034）。单因素分析显示，肝转移灶最大直径<6 cm和转移灶数量≤4个是与转化治疗成功相关的独立因素。根据患者具体情况，6例接受肝切除联合消融，1例接受门静脉结扎分期切除。
CRLM患者的治疗应遵循规范化和个体化原则。对于初始不可切除的CRLM患者，应尽可能追求转化治疗成功。肝转移灶的最大尺寸和数量与转化治疗成功显著相关。以手术切除为主的综合治疗是关键。
