Boraschi Piero, Moretto Roberto, Donati Francescamaria, Borelli Beatrice, Mercogliano Giuseppe, Giugliano Luigi, Boccaccino Alessandra, Della Pina Maria Clotilde, Colombatto Piero, Signori Stefano, Masi Gianluca, Cremolini Chiara, Urbani Lucio
Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy.
Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy.
Cancers (Basel). 2023 Apr 8;15(8):2200. doi: 10.3390/cancers15082200.
We aimed to evaluate the outcome of the disappearance or small remnants of colorectal liver metastases during first-line chemotherapy assessed by hepatobiliary contrast-enhanced and diffusion-weighted MR imaging (DW-MRI). Consecutive patients with at least one disappearing liver metastasis (DLM) or small residual liver metastases (≤10 mm) assessed by hepatobiliary contrast-enhanced and DW-MRI during first-line chemotherapy were included. Liver lesions were categorized into three groups: DLM; residual tiny liver metastases (RTLM) when ≤5 mm; small residual liver metastases (SRLM) when >5mm and ≤10 mm. The outcome of resected liver metastases was assessed in terms of pathological response, whereas lesions left in situ were evaluated in terms of local relapse or progression. Fifty-two outpatients with 265 liver lesions were radiologically reviewed; 185 metastases fulfilled the inclusion criteria: 40 DLM, 82 RTLM and 60 SRLM. We observed a pCR rate of 75% (3/4) in resected DLM and 33% (12/36) of local relapse for DLM left in situ. We observed a risk of relapse of 29% and 57% for RTLM and SRLM left in situ, respectively, and a pCR rate of about 40% overall for resected lesions. DLM assessed via hepatobiliary contrast-enhanced and DW-MRI very probably indicates a complete response. The surgical removal of small remnants of liver metastases should always be advocated whenever technically possible.
我们旨在评估在一线化疗期间通过肝胆对比增强和扩散加权磁共振成像（DW-MRI）评估的结直肠癌肝转移灶消失或残留小病灶的结果。纳入在一线化疗期间通过肝胆对比增强和DW-MRI评估至少有一个肝转移灶消失（DLM）或残留小肝转移灶（≤10 mm）的连续患者。肝病灶分为三组：DLM；残留微小肝转移灶（RTLM，≤5 mm时）；小残留肝转移灶（SRLM，>5 mm且≤10 mm时）。对切除的肝转移灶的结果根据病理反应进行评估，而原位保留的病灶则根据局部复发或进展进行评估。对52例有265个肝病灶的门诊患者进行了影像学复查；185个转移灶符合纳入标准：40个DLM、82个RTLM和60个SRLM。我们观察到切除的DLM的病理完全缓解（pCR）率为75%（3/4），原位保留的DLM局部复发率为33%（12/36）。我们观察到原位保留的RTLM和SRLM的复发风险分别为29%和57%，切除病灶的总体pCR率约为40%。通过肝胆对比增强和DW-MRI评估的DLM很可能表明完全缓解。只要技术上可行，应始终提倡手术切除肝转移灶的小残留病灶。
