对1086例芬兰转移性结直肠癌患者进行可切除性、临床行为及预后的重复集中多学科团队评估（RAXO）：一项全国性前瞻性干预研究。

Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): A nationwide prospective intervention study.

作者信息

Osterlund Pia, Salminen Tapio, Soveri Leena-Maija, Kallio Raija, Kellokumpu Ilmo, Lamminmäki Annamarja, Halonen Päivi, Ristamäki Raija, Lantto Eila, Uutela Aki, Osterlund Emerik, Ovissi Ali, Nordin Arno, Heervä Eetu, Lehtomäki Kaisa, Räsänen Jari, Murashev Maija, Aroviita Laura, Jekunen Antti, Lindvall-Andersson Reneé, Nyandoto Paul, Kononen Juha, Lepistö Anna, Poussa Tuija, Muhonen Timo, Ålgars Annika, Isoniemi Helena

机构信息

Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland.

Department of Oncology, Helsinki University Hospital, Helsinki, Finland.

出版信息

Lancet Reg Health Eur. 2021 Jan 29;3:100049. doi: 10.1016/j.lanepe.2021.100049. eCollection 2021 Apr.

BACKGROUND

Resection of colorectal cancer (CRC) metastases provides good survival but is probably underused in real-world practice.

METHODS

A prospective Finnish nationwide study enrolled treatable metastatic CRC patients. The intervention was the assessment of resectability upfront and twice during first-line therapy by the multidisciplinary team (MDT) at Helsinki tertiary referral centre. The primary outcome was resection rates and survival.

FINDINGS

In 2012-2018, 1086 patients were included. Median follow-up was 58 months. Multiple metastatic sites were present in 500 (46%) patients at baseline and in 820 (76%) during disease trajectory. In MDT assessments, 447 (41%) were classified as resectable, 310 (29%) upfront and 137 (18%) after conversion therapy. Six-hundred and ninety curative intent resections or local ablative therapies (LAT) were performed in 399 patients (89% of 447 resectable). Multiple metastasectomies for multisite or later developing metastases were performed in 148 (37%) patients. Overall, 414 liver, 112 lung, 57 peritoneal, and 107 other metastasectomies were performed. Median OS was 80·4 months in R0/1-resected (HR 0·15; CI 0·12-0·19), 39·1 months in R2-resected/LAT (0·39; 0·29-0·53) patients, and 20·8 months in patients treated with "systemic therapy alone" (reference), with 5-year OS rates of 66%, 40%, and 6%, respectively.

INTERPRETATION

Repeated centralized MDT assessment in real-world metastatic CRC patients generates high resectability (41%) and resection rates (37%) with impressive survival, even when multisite metastases are present or develop later.

FUNDING

The funders had no role in the study design, analysis, and interpretation of the data or writing of this report.

背景

结直肠癌（CRC）转移灶的切除可带来良好的生存率，但在实际临床实践中可能未得到充分应用。

方法

一项芬兰全国性前瞻性研究纳入了可治疗的转移性CRC患者。干预措施是由赫尔辛基三级转诊中心的多学科团队（MDT）在一线治疗开始时及治疗过程中两次对手术可切除性进行评估。主要结局指标是切除率和生存率。

研究结果

2012年至2018年，共纳入1086例患者。中位随访时间为58个月。基线时500例（46%）患者存在多个转移部位，疾病进展过程中有820例（76%）患者出现多个转移部位。在MDT评估中，447例（41%）被分类为可切除，其中310例（29%）在治疗开始时被评估为可切除，137例（18%）在转化治疗后被评估为可切除。399例患者（占447例可切除患者的89%）接受了690例根治性切除或局部消融治疗（LAT）。148例（37%）患者因多部位转移或后续出现的转移灶接受了多次转移灶切除术。总体而言，共进行了414例肝脏转移灶切除、112例肺转移灶切除、57例腹膜转移灶切除和107例其他转移灶切除。R0/1切除患者的中位总生存期（OS）为80.4个月（风险比[HR] 0.15；95%置信区间[CI] 0.12 - 0.19），R2切除/LAT患者为39.1个月（HR 0.39；CI 0.29 - 0.53），“仅接受全身治疗”的患者（作为对照）为20.8个月，5年OS率分别为66%、40%和6%。