Burlaka Anton, Ryzhov Anton, Ostapenko Yurii, Bankovska Natalia, Kopchak Kostiantyn, Zvirych Vitalii, Golovko Tetiana, Shypko Andriy, Lukashenko Andrii
Departments of Colorectal Cancer.
Department of Cancer Control, National Cancer Registry of Ukraine, Kyiv, Ukraine.
Ann Med Surg (Lond). 2023 Apr 13;85(5):1413-1419. doi: 10.1097/MS9.0000000000000619. eCollection 2023 May.
For the last three decades, the world surgical community successfully adopted different surgical strategies for colorectal cancer (CRC) patients with liver metastases (LM), however, we are still seeing the evolution of treatment guidelines. The purpose of the study was to analyze a 20-year evolution of CRC patients with LM being treated in a specialized state Ukrainian oncological center.
The retrospective analysis of 1118 CRC patient cases using prospectively collected patient data from the National Cancer Institute registry. The time ranges between 2000-2010 and 2011-2022 and the LM manifestation - metachronous (M0)/synchronous (M1) were the two main grouping criteria.
The overall survival 5-year survival of patients who had surgery between 2000-2011 and 2012-2022 was 51.3 and 58.2% (=0.61) for the M0 cohort and 22.6 and 34.7% at M1 (=0.002), respectively. The results of the multivariate analysis in 1118 cases revealed that liver re-resection and regional lymph node dissection ≥D2 were associated with better overall survival [hazard ratio (95% CI)=0.76 (0.58-0.99) =0.04] in the M0 cohort and receiving at least 15 courses of chemotherapy had better recurrence-free survival rates [hazard ratio (95% CI)=0.97 (0.95-0.99), =0.03] for both M0 and M1.
It was shown the improvement of the oncological prognosis for CRC patients with synchronous LM who were treated after 2012. The adaptation of world experience algorithms and the surgical strategy evolution have become the root cause of the above.
在过去三十年里，世界外科界成功地为患有肝转移（LM）的结直肠癌（CRC）患者采用了不同的手术策略，然而，我们仍在见证治疗指南的演变。本研究的目的是分析在乌克兰一家专业肿瘤中心接受治疗的患有LM的CRC患者的20年演变情况。
对1118例CRC患者病例进行回顾性分析，使用从国家癌症研究所登记处前瞻性收集的患者数据。时间范围为2000 - 2010年和2011 - 2022年，LM表现——异时性（M0）/同时性（M1）是两个主要分组标准。
2000 - 2011年和2012 - 2022年接受手术的患者中，M0队列的5年总生存率分别为51.3%和58.2%（=0.61），M1队列分别为22.6%和34.7%（=0.002）。对1118例病例的多变量分析结果显示，在M0队列中，肝再次切除术和≥D2区域淋巴结清扫与更好的总生存率相关[风险比（95%置信区间）=0.76（0.58 - 0.99），=0.04]，并且接受至少15个疗程化疗的M0和M1患者无复发生存率更高[风险比（95%置信区间）=0.97（0.95 - 0.99），=0.03]。
结果表明，2012年后接受治疗的同时性LM的CRC患者的肿瘤学预后有所改善。世界经验算法的应用和手术策略的演变是上述情况的根本原因。
