标准化随访和多模式管理后结直肠癌肝转移的高切除率：COLOFOL 试验中的一项结局研究。

High resection rates of colorectal liver metastases after standardized follow-up and multimodal management: an outcome study within the COLOFOL trial.

机构信息

Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.

Department of Surgery, Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Surgery, Skane University Hospital, Malmö, Sweden.

出版信息

HPB (Oxford). 2023 Jul;25(7):766-774. doi: 10.1016/j.hpb.2023.03.003. Epub 2023 Mar 9.

DOI:10.1016/j.hpb.2023.03.003

PMID:36967324

Abstract

BACKGROUND

Outcome after colorectal liver metastases (CRLM) resection has improved over time, despite increased resection rates. Hence, it's crucial to identify all patients possible to treat with curative intent. The objectives of this study were to map recurrence pattern, treatment strategy and survival depending on treatment and follow-up strategy.

METHODS

In the COLOFOL-trial, patients with radically resected stage II-III colorectal cancer were randomized to high-frequency (6, 12, 18, 24 and 36 months; HF) or low-frequency (12 and 36 months; LF) follow-up. In this study, all CRLM within 5 years were identified and medical files scrutinized. Overall survival (OS) was analysed in uni- and multivariable analyses. Primary endpoint was 5-year OS.

RESULTS

Of 2442 patients, 235 (9.6%) developed metachronous CRLM of which 123 (52.3%) underwent treatment with curative intent, resulting in 5-year OS of 58%. Five-year OS for patients with CRLM was 43% after HF versus 24% after LF. The survival benefit was confirmed for HF 8 years from resection of the primary tumour, HR 0.63 (CI 0.46-0.85).

CONCLUSION

A high proportion of metachronous CRLM was possible to treat with curative intent, yielding high survival rates. More intense follow-up after colorectal cancer resection might be of value in high-risk patients.

摘要

背景

尽管结直肠肝转移（CRLM）切除术后的切除率有所提高，但术后的结果仍在改善。因此，确定所有可能具有治愈意图的患者进行治疗是至关重要的。本研究的目的是根据治疗和随访策略，描绘复发模式、治疗策略和生存情况。

方法

在 COLOFOL 试验中，接受根治性切除的 II-III 期结直肠癌患者被随机分为高频（6、12、18、24 和 36 个月；HF）或低频（12 和 36 个月；LF）随访组。在这项研究中，所有 5 年内出现的 CRLM 均被识别出来，并仔细检查了病历。使用单变量和多变量分析方法分析总生存期（OS）。主要终点为 5 年 OS。

结果

在 2442 例患者中，有 235 例（9.6%）发生了异时性 CRLM，其中 123 例（52.3%）接受了治愈性治疗，5 年 OS 为 58%。接受高频随访的患者 5 年 OS 为 43%，而接受低频随访的患者为 24%。从原发性肿瘤切除 8 年开始，HF 的生存获益得到证实，HR 为 0.63（95%CI：0.46-0.85）。