Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
BMC Surg. 2021 Apr 9;21(1):188. doi: 10.1186/s12893-021-01193-4.
Expansion of the indication for liver resection and new regimens for systemic chemotherapy have improved postoperative outcomes for synchronous colorectal liver metastases (CRLM). However, such cases can still have a high recurrence rate, even after curative resection. Therefore, there is a need for postoperative adjuvant chemotherapy (POAC) after liver resection in patients with CRLM. There are few studies of the efficacy of POAC with an oxaliplatin-based regimen after simultaneous resection for colorectal cancer and CRLM with curative intent. The goal of the study was to compare POAC with oxaliplatin-based and fluoropyrimidine regimens using propensity score (PS) matching analysis.
The subjects were 94 patients who received POAC after simultaneous resection for colorectal cancer and synchronous CRLM, and were enrolled retrospectively. The patients were placed in a L-OHP (+) group (POAC with an oxaliplatin-based regimen, n = 47) and a L-OHP (-) group (POAC with a fluoropyrimidine regimen, n = 47). Recurrence-free (RFS), cancer-specific (CSS), unresectable recurrence-free (URRFS), remnant liver recurrence-free (RLRFS), and extrahepatic recurrence-free (EHRFS) survival were analyzed.
Before PS matching, the L-OHP (+) and (-) groups had no significant differences in RFS, CSS, URRFS, RLRFS, and EHRFS. Univariate analysis indicated significant differences in age, preoperative serum CEA (≤ 30.0 ng/mL/ > 30.0 ng/mL), differentiation of primary tumor (differentiated/undifferentiated), T classification (T1-3/T4), number of hepatic lesions and maximum diameter of the hepatic lesion between the L-OHP (+) and (-) groups. After PS matching using these confounders, RFS was significantly better among patients in the L-OHP (+) group compared with the L-OHP (-) group (HR 0.40, 95% CI 0.17-0.96, p = 0.04). In addition, there was a trend towards better RLRFS among patients in the L-OHP (+) group compared with the L-OHP (-) group (HR 0.42, 95% CI 0.17-1.02, p = 0.055). However, there were no significant differences in CSS, URRFS and EHRFS between the L-OHP (+) and (-) groups.
PS matching analysis demonstrated the efficacy of POAC with an oxaliplatin-based regimen in RFS and RLRFS.
肝切除术适应证的扩大和全身化疗新方案的应用改善了同步结直肠癌肝转移（CRLM）患者的术后转归。然而，即使在根治性切除后，这些患者仍有很高的复发率。因此，CRLM 患者在肝切除术后需要辅助化疗（POAC）。针对同时行结直肠癌根治术和 CRLM 根治性切除术患者，应用奥沙利铂为基础的方案行 POAC 的疗效研究较少。本研究的目的是通过倾向性评分（PS）匹配分析比较奥沙利铂为基础和氟嘧啶为基础方案的 POAC 的疗效。
回顾性纳入 94 例行同时性结直肠癌和同步 CRLM 根治性切除术后接受 POAC 的患者。将患者分为 L-OHP（+）组（奥沙利铂为基础的 POAC 方案，n=47）和 L-OHP（-）组（氟嘧啶为基础的 POAC 方案，n=47）。分析无复发生存（RFS）、癌症特异性生存（CSS）、不可切除性无复发生存（URRFS）、残肝无复发生存（RLRFS）和肝外无复发生存（EHRFS）。
在 PS 匹配之前，L-OHP（+）组和（-）组的 RFS、CSS、URRFS、RLRFS 和 EHRFS 无显著差异。单因素分析显示，L-OHP（+）组和（-）组在年龄、术前血清 CEA（≤30.0ng/mL/＞30.0ng/mL）、原发肿瘤分化（分化/未分化）、T 分类（T1-3/T4）、肝内病变数目和肝内病变最大直径方面存在显著差异。使用这些混杂因素进行 PS 匹配后，L-OHP（+）组的 RFS 显著优于 L-OHP（-）组（HR 0.40，95%CI 0.17-0.96，p=0.04）。此外，L-OHP（+）组的 RLRFS 有改善趋势（HR 0.42，95%CI 0.17-1.02，p=0.055）。然而，L-OHP（+）组和（-）组的 CSS、URRFS 和 EHRFS 无显著差异。
PS 匹配分析显示奥沙利铂为基础方案的 POAC 在 RFS 和 RLRFS 方面有疗效。
