M Janesh, Kazi Mufaddal, Patkar Shraddha, S Prudvi Raj, Bhoyar Abhiram, Desouza Ashwin, Saklani Avanish, Goel Mahesh
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India.
Homi Bhabha National Institute, Mumbai, 400012, India.
J Clin Exp Hepatol. 2023 Sep-Oct;13(5):753-759. doi: 10.1016/j.jceh.2023.03.009. Epub 2023 Mar 31.
While half of the patients with colorectal cancer develop metastasis, some 20% develop liver-only disease, and 10% of patients with unresectable liver disease live for 5 years. This study audits the outcomes of patients with colorectal liver metastasis to identify patients with unresectable liver metastasis eligible for a liver transplant.
All patients with colorectal liver metastasis, irrespective of the presence of metastasis at other sites, registered between January 1, 2018, and December 31, 2019, were included in this retrospective audit. Patients in whom R0 Resection with adequate future liver remnant was not possible even after downstaging with chemotherapy were deemed unresectable. Overall survival was calculated using the Kaplan-Meier analysis. Patients eligible for a liver transplant were identified using the International Hepato-Pancreatico-Biliary Association (IHBPA) consensus guidelines and Oslo and Fong clinical risk scores.
Out of 284 patients, 80 were treated with curative intent and 185 with palliative intent. At a median follow-up of 36 months, the median and 3-year OS were 37 months and 55% for the curative intent group and 9 months and 4% for the palliative intent group, respectively. Among 173 patients with liver-only metastasis, 13 patients (7%) satisfied the IHBPA consensus guidelines and had both Oslo and Fong scores of 2 or less. Transplant-eligible patients with unresectable liver metastasis had median and 3-year OS of 24 months and 25% against 9 months and 5% for ineligible patients, respectively.
Liver transplant has the potential to benefit a small but significant portion of patients with unresectable liver metastasis.
虽然一半的结直肠癌患者会发生转移，但约20%的患者仅出现肝脏转移，且10%的不可切除肝脏疾病患者能存活5年。本研究评估了结直肠癌肝转移患者的治疗结果，以确定适合肝移植的不可切除肝转移患者。
本回顾性评估纳入了2018年1月1日至2019年12月31日期间登记的所有结直肠癌肝转移患者，无论其他部位是否存在转移。即使在化疗降期后仍无法进行R0切除且保留足够未来肝体积的患者被视为不可切除。采用Kaplan-Meier分析计算总生存期。根据国际肝胰胆协会（IHBPA）共识指南以及奥斯陆和方氏临床风险评分来确定适合肝移植的患者。
在284例患者中，80例接受了根治性治疗，185例接受了姑息性治疗。中位随访36个月时，根治性治疗组的中位总生存期和3年总生存率分别为37个月和55%，姑息性治疗组分别为9个月和4%。在173例仅发生肝脏转移的患者中，13例（7%）符合IHBPA共识指南，奥斯陆和方氏评分均为2分或更低。符合移植条件的不可切除肝转移患者的中位总生存期和3年总生存率分别为24个月和25%，不符合条件的患者分别为9个月和5%。
肝移植有可能使一小部分但相当数量的不可切除肝转移患者受益。
