Jiang Yu-Juan, Zhou Si-Cheng, Chen Jing-Hua, Liang Jian-Wei
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Oct 18;12:951540. doi: 10.3389/fonc.2022.951540. eCollection 2022.
The efficacy and safety of neoadjuvant chemotherapy (NAC) in treating resectable synchronous colorectal liver metastases (CRLM) remain controversial.
Data from CRLM patients who underwent simultaneous liver resection between January 2015 and December 2019 were collected from the Surveillance, Epidemiology, and End Results (SEER) database (SEER cohort, n=305) and a single Chinese Cancer Center (NCC cohort, n=268). Using a 1:2 ratio of propensity score matching (PSM), the prognostic impact of NAC for patients who underwent NAC before surgical treatment and patients who underwent surgical treatment alone was evaluated.
After PSM, there was no significant difference in overall survival (OS) between patients receiving NAC prior to CRLM resection and those undergoing surgery only, in both the NCC and SEER cohorts (each > 0.05). Age was an independent predictor of OS only in the SEER cohort ( = 0.040), while the pN stage was an independent predictor for OS only in the NCC cohort ( = 0.002). Furthermore, Disease-free survival (DFS) was comparable between the two groups in the NCC cohort. In a subgroup analysis, the DFS and OS in the NAC- group were significantly worse than those in the NAC+ group for patients with more than two liver metastases in the NCC cohort ( < 0.05 for both).
NAC did not have a significant prognostic impact in patients with resectable synchronous CRLM. However, patients with more than two liver metastases could be good candidates for receiving NAC.
新辅助化疗（NAC）治疗可切除的同步性结直肠癌肝转移（CRLM）的疗效和安全性仍存在争议。
从监测、流行病学和最终结果（SEER）数据库（SEER队列，n = 305）和一家中国癌症中心（NCC队列，n = 268）收集2015年1月至2019年12月期间接受同期肝切除的CRLM患者的数据。采用倾向评分匹配（PSM）1:2的比例，评估NAC对手术治疗前接受NAC的患者和仅接受手术治疗的患者的预后影响。
PSM后，NCC和SEER队列中，CRLM切除术前接受NAC的患者与仅接受手术的患者的总生存期（OS）无显著差异（均P>0.05）。年龄仅是SEER队列中OS的独立预测因素（P = 0.040），而pN分期仅是NCC队列中OS的独立预测因素（P = 0.002）。此外，NCC队列中两组的无病生存期（DFS）相当。在亚组分析中，NCC队列中肝转移超过两处的患者，NAC-组的DFS和OS显著低于NAC+组（两者均P<0.05）。
NAC对可切除的同步性CRLM患者的预后无显著影响。然而，肝转移超过两处的患者可能是接受NAC的合适人选。
