确定非结直肠癌肝转移的外科治疗方法。

Defining the surgical management for non-colorectal liver metastases.

作者信息

Luk Yan, She Wong Hoi, Tsang Simon H Y, Dai Wing Chiu, Chan Albert C Y, Cheung Tan To, Lo Chung Mau

机构信息

Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.

出版信息

Langenbecks Arch Surg. 2023 Jan 17;408(1):35. doi: 10.1007/s00423-023-02767-x.

DOI:10.1007/s00423-023-02767-x

PMID:36648566

Abstract

BACKGROUND

Surgical resection is indicated for resectable colorectal liver metastases (CLM), but it is controversial for non-colorectal liver metastases (NCLM). This study aimed to compare survival outcomes of patients with resection of NCLM versus CLM and to identify prognostic factors for resection of NCLM.

METHODS

Consecutive patients who underwent surgical resection of liver metastases at Queen Mary Hospital, Hong Kong from January 1989 to December 2019 were retrospectively reviewed. Patients with resected NCLM were compared to those with CLM. Overall and recurrence-free survival were determined. Subgroup analyses with patients grouped according to the year of liver resection, from 1989 to 2004 and from 2005 to 2019, were conducted. Univariate and multivariate analyses were performed to identify prognostic factors.

RESULTS

Among 674 patients included, 151 (22.4%) had NCLM while 523 (77.6%) had CLM. There were no statistically significant differences in median overall survival (65.2 vs 43.6 months, p = 0.555) and recurrence-free survival (12.5 vs 11.7 months, p = 0.425). The 1-year, 3-year, 5-year and 10-year overall survival rates were 89.8% vs 91.5%, 59.4% vs 58.8%, 50.6% vs 38.7% and 34.1% vs 26.3% in NCLM and CLM groups, respectively. Subgroup analyses demonstrated no statistically significant difference in overall survival between resection of NCLM versus CLM in both time intervals. In the NCLM group, better overall survival was found in liver metastasis of gastrointestinal stromal tumour (GIST) origin (hazard ratio (HR) 0.138, p = 0.003) and with a longer time interval from resection of primary tumour to resection of NCLM (HR 0.982, p = 0.042). Poor prognostic factors were presence of blood transfusion (HR 5.588, p = 0.013) and post-operative complications of Clavien-Dindo Grade IIIa or above (HR 74.853, p = 0.003).

CONCLUSIONS

Surgical resection of NCLM had comparable survival outcomes with CLM. With appropriate patient selection, the indication of liver resection could be expanded to NCLM.

摘要

背景

手术切除适用于可切除的结直肠癌肝转移（CLM），但对于非结直肠癌肝转移（NCLM）存在争议。本研究旨在比较NCLM与CLM患者手术切除后的生存结局，并确定NCLM手术切除的预后因素。

方法

回顾性分析1989年1月至2019年12月在香港玛丽医院接受肝转移瘤手术切除的连续患者。将接受NCLM切除的患者与CLM患者进行比较。确定总生存期和无复发生存期。对1989年至2004年以及2005年至2019年根据肝切除年份分组的患者进行亚组分析。进行单因素和多因素分析以确定预后因素。

结果

在纳入的674例患者中，151例（22.4%）为NCLM，523例（77.6%）为CLM。中位总生存期（65.2个月对43.6个月，p = 0.555）和无复发生存期（12.5个月对11.7个月，p = 0.425）无统计学显著差异。NCLM组和CLM组的1年、3年、5年和10年总生存率分别为89.8%对91.5%、59.4%对58.8%、50.6%对38.7%和34.1%对26.3%。亚组分析表明，在两个时间间隔内，NCLM与CLM切除后的总生存期无统计学显著差异。在NCLM组中，胃肠道间质瘤（GIST）起源的肝转移（风险比（HR）0.138，p = 0.003）以及从原发性肿瘤切除到NCLM切除的时间间隔较长（HR 0.982，p = 0.042）患者的总生存期较好。不良预后因素为输血（HR 5.588，p = 0.013）和Clavien-Dindo IIIa级或以上的术后并发症（HR 74.853，p = 0.