荷兰CAIRO5试验中现代诱导全身治疗后初始不可切除的结直肠癌肝转移二次肝手术的短期结局
Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial.
作者信息
Bolhuis Karen, Grosheide Lodi, Wesdorp Nina J, Komurcu Aysun, Chapelle Thiery, Dejong Cornelis H C, Gerhards Michael F, Grünhagen Dirk J, van Gulik Thomas M, Huiskens Joost, De Jong Koert P, Kazemier Geert, Klaase Joost M, Liem Mike S L, Molenaar I Quintus, Patijn Gijs A, Rijken Arjen M, Ruers Theo M, Verhoef Cornelis, de Wilt Johannes H W, Punt Cornelis J A, Swijnenburg Rutger-Jan
机构信息
From the Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, The Netherlands.
出版信息
Ann Surg Open. 2021 Jul 23;2(3):e081. doi: 10.1097/AS9.0000000000000081. eCollection 2021 Sep.
OBJECTIVE
To present short-term outcomes of liver surgery in patients with initially unresectable colorectal liver metastases (CRLM) downsized by chemotherapy plus targeted agents.
BACKGROUND
The increase of complex hepatic resections of CRLM, technical innovations pushing boundaries of respectability, and use of intensified induction systemic regimens warrant for safety data in a homogeneous multicenter prospective cohort.
METHODS
Patients with initially unresectable CRLM, who underwent complete resection after induction systemic regimens with doublet or triplet chemotherapy, both plus targeted therapy, were selected from the ongoing phase III CAIRO5 study (NCT02162563). Short-term outcomes and risk factors for severe postoperative morbidity (Clavien Dindo grade ≥ 3) were analyzed using logistic regression analysis.
RESULTS
A total of 173 patients underwent resection of CRLM after induction systemic therapy. The median number of metastases was 9 and 161 (93%) patients had bilobar disease. Thirty-six (20.8%) 2-stage resections and 88 (51%) major resections (>3 liver segments) were performed. Severe postoperative morbidity and 90-day mortality was 15.6% and 2.9%, respectively. After multivariable analysis, blood transfusion (odds ratio [OR] 2.9 [95% confidence interval (CI) 1.1-6.4], 0.03), major resection (OR 2.9 [95% CI 1.1-7.5], 0.03), and triplet chemotherapy (OR 2.6 [95% CI 1.1-7.5], 0.03) were independently correlated with severe postoperative complications. No association was found between number of cycles of systemic therapy and severe complications ( = -0.038 = 0.31).
CONCLUSION
In patients with initially unresectable CRLM undergoing modern induction systemic therapy and extensive liver surgery, severe postoperative morbidity and 90-day mortality were 15.6% and 2.7%, respectively. Triplet chemotherapy, blood transfusion, and major resections were associated with severe postoperative morbidity.
目的
介绍经化疗联合靶向药物治疗后肿瘤缩小的初始不可切除的结直肠癌肝转移（CRLM）患者肝手术的短期疗效。
背景
CRLM复杂肝切除术的增加、推动手术可接受性边界的技术创新以及强化诱导全身治疗方案的使用，均需要在同质的多中心前瞻性队列中获取安全性数据。
方法
从正在进行的III期CAIRO5研究（NCT02162563）中选取初始不可切除的CRLM患者，这些患者在接受含双药或三药化疗联合靶向治疗的诱导全身治疗方案后接受了完整切除。采用逻辑回归分析对严重术后并发症（Clavien Dindo分级≥3级）的短期疗效和危险因素进行分析。
结果
共有173例患者在诱导全身治疗后接受了CRLM切除术。转移灶的中位数为9个，161例（93%）患者为双侧病变。进行了36例（20.8%）二期切除术和88例（51%）大切除术（>3个肝段）。严重术后并发症发生率和90天死亡率分别为15.6%和2.9%。多变量分析后，输血（比值比[OR]2.9[95%置信区间（CI）1.1 - 6.4]，P = 0.03）、大切除术（OR 2.9[95%CI 1.1 - 7.5]，P = 0.03）和三药化疗（OR 2.6[95%CI 1.1 - 7.5]，P = 0.03）与严重术后并发症独立相关。未发现全身治疗周期数与严重并发症之间存在关联（P = -0.038，P = 0.31）。
结论
在接受现代诱导全身治疗和广泛肝手术的初始不可切除的CRLM患者中，严重术后并发症发生率和90天死亡率分别为15.6%和2.7%。三药化疗、输血和大切除术与严重术后并发症相关。
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