HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
Ann Surg Oncol. 2022 Oct;29(11):6829-6842. doi: 10.1245/s10434-022-12027-9. Epub 2022 Jul 18.
There is still debate regarding the principal role and ideal timing of perioperative chemotherapy (CTx) for patients with upfront resectable colorectal liver metastases (CRLM). This study assesses long-term oncological outcomes in patients receiving neoadjuvant CTx only versus those receiving neoadjuvant combined with adjuvant therapy (perioperative CTx).
International multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010 and 2015. Characteristics and outcomes were compared before and after propensity score matching (PSM). Primary endpoints were long-term oncological outcomes, such as recurrence-free survival (RFS) and overall survival (OS). Furthermore, stratification by the tumour burden score (TBS) was applied.
Of 967 patients undergoing hepatectomy, 252 were analysed, with a median follow-up of 45 months. The unmatched comparison revealed a bias towards patients with neoadjuvant CTx presenting with more high-risk patients (p = 0.045) and experiencing increased postoperative complications ≥Clavien-Dindo III (20.9% vs. 8%, p = 0.003). Multivariable analysis showed that perioperative CTx was associated with significantly improved RFS (hazard ratio [HR] 0.579, 95% confidence interval [CI] 0.420-0.800, p = 0.001) and OS (HR 0.579, 95% CI 0.403-0.834, p = 0.003). After PSM (n = 180 patients), the two groups were comparable regarding baseline characteristics. The perioperative CTx group presented with a significantly prolonged RFS (HR 0.53, 95% CI 0.37-0.76, p = 0.007) and OS (HR 0.58, 95% CI 0.38-0.87, p = 0.010) in both low and high TBS patients.
When patients after resection of CRLM are able to tolerate additional postoperative CTx, a perioperative strategy demonstrates increased RFS and OS in comparison with neoadjuvant CTx only in both low and high-risk situations.
对于可直接切除的结直肠肝转移（CRLM）患者，围手术期化疗（CTx）的主要作用和理想时机仍存在争议。本研究评估了仅接受新辅助 CTx 与接受新辅助联合辅助治疗（围手术期 CTx）的患者的长期肿瘤学结果。
对 2010 年至 2015 年间接受肝切除术的 CRLM 患者进行国际多中心回顾性分析。在进行倾向评分匹配（PSM）前后比较特征和结果。主要终点是无复发生存（RFS）和总体生存（OS）等长期肿瘤学结果。此外，还应用了肿瘤负担评分（TBS）进行分层。
在 967 例接受肝切除术的患者中，分析了 252 例患者，中位随访时间为 45 个月。未匹配的比较显示，接受新辅助 CTx 的患者更倾向于存在更多高危患者（p = 0.045），并经历术后并发症≥Clavien-Dindo III 级（20.9% vs. 8%，p = 0.003）的可能性更高。多变量分析表明，围手术期 CTx 与显著改善的 RFS（风险比[HR]0.579，95%置信区间[CI]0.420-0.800，p = 0.001）和 OS（HR 0.579，95% CI 0.403-0.834，p = 0.003）相关。在 PSM（n = 180 例患者）后，两组在基线特征方面具有可比性。围手术期 CTx 组在低 TBS 和高 TBS 患者中均表现出显著延长的 RFS（HR 0.53，95% CI 0.37-0.76，p = 0.007）和 OS（HR 0.58，95% CI 0.38-0.87，p = 0.010）。
在能够耐受额外术后 CTx 的 CRLM 切除后患者中，与仅接受新辅助 CTx 相比，围手术期策略在低危和高危情况下均显示出更高的 RFS 和 OS。
