Canseco Lariza Marie, Liu Yueh-Wei, Lu Chien-Chang, Lee Ko-Chao, Chen Hong-Hwa, Hu Wan-Hsiang, Tsai Kai-Lung, Yang Yao-Hsu, Wang Chih-Chi, Hung Chao-Hung
Section of Gastroenterology, Department of Internal Medicine, De Los Santos Medical Center, Quezon City 1112, MM, Philippines.
Liver Transplant Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan.
Cancers (Basel). 2023 Sep 6;15(18):4434. doi: 10.3390/cancers15184434.
Hepatectomy and/or local ablation therapy have been recommended for colorectal cancer liver metastases (CRLM). However, they still lack strong evidence for their survival benefits, in addition to systemic therapy. This study aims to evaluate the survival evidence of hepatectomy and/or radiofrequency ablation (RFA) therapy in CRLM patients from a large multi-institutional database. A total of 20,251 patients with colorectal cancer, 4521 of whom were with CRLM, were screened for eligibility. Finally, 2612 patients (637 hepatectomy, 93 RFA, 92 combined hepatectomy and RFA, and 1790 non-aggressive treatment) were enrolled. Frequency matching analysis was used to adjust for baseline differences. The 5-year overall survival (OS) was as follows: hepatectomy alone was 47.8%, combined hepatectomy plus RFA was 35.9%, RFA alone was 29.2%, and the non-aggressive treatment group was 7.4%. Kaplan-Meier curves showed that hepatectomy, RFA, and combination were significantly associated with a better OS compared to those without aggressive local therapy ( < 0.001). Multivariate Cox regression analysis showed that male gender (hazard ratio (HR) 0.89; 95% confidence interval (CI), 0.81-0.97; = 0.011), old age (≥60 years) (HR 1.20; 95% CI, 1.09-1.32; < 0.001), high CEA level (>5 ng/mL) (HR 2.14; 95% CI, 1.89-2.42; < 0.001), primary right-sided cancer (HR 1.35; 95% CI, 1.22-1.51; < 0.001), extrahepatic metastasis (HR 1.46; 95% CI, 1.33-1.60; < 0.001), systemic therapy (HR 0.7; 95% CI, 0.62-0.79; < 0.001), and aggressive local therapy (hepatectomy vs. non-local therapy HR 0.22; 95% CI, 0.20-0.26; < 0.001; RFA vs. non-local therapy HR 0.29; 95% CI, 0.29-0.41; < 0.001) were independent factors associated with OS. In the frequency matching analysis, patients receiving hepatectomy and/or RFA resulted in a better OS than those without ( < 0.001). In conclusion, aggressive local treatment provides survival advantages over systemic therapy alone among CRLM patients.
肝切除术和/或局部消融治疗已被推荐用于治疗结直肠癌肝转移（CRLM）。然而，除了全身治疗外，它们在生存获益方面仍缺乏有力证据。本研究旨在从一个大型多机构数据库评估CRLM患者接受肝切除术和/或射频消融（RFA）治疗的生存证据。共筛选了20251例结直肠癌患者，其中4521例为CRLM患者以确定其是否符合条件。最终，纳入了2612例患者（637例行肝切除术，93例行RFA，92例行肝切除术联合RFA，1790例接受非积极治疗）。采用频率匹配分析来调整基线差异。5年总生存率（OS）如下：单纯肝切除术为47.8%，肝切除术联合RFA为35.9%，单纯RFA为29.2%，非积极治疗组为7.4%。Kaplan-Meier曲线显示，与未接受积极局部治疗的患者相比，肝切除术、RFA及联合治疗组的OS明显更好（P<0.001）。多因素Cox回归分析显示男性（风险比（HR）0.89；95%置信区间（CI），0.81 - 0.97；P = 0.011）、老年（≥60岁）（HR 1.20；95%CI，1.09 - 1.32；P<0.001）、癌胚抗原（CEA）水平高（>5 ng/mL）（HR 2.14；95%CI，1.89 - 2.42；P<0.001）、原发于右侧的癌症（HR 1.35；95%CI，1.22 - 1.51；P<0.001）、肝外转移（HR 1.46；95%CI，1.33 - 1.60；P<0.001）、全身治疗（HR 0.7；95%CI，0.62 - 0.79；P<0.001）以及积极局部治疗（肝切除术与非局部治疗相比HR 0.22；95%CI，0.20 - 0.26；P<0.001；RFA与非局部治疗相比HR 0.29；95%CI，0.29 - 0.41；P<0.001）是与OS相关的独立因素。在频率匹配分析中，接受肝切除术和/或RFA的患者的OS优于未接受者（P<0.001）。总之，在CRLM患者中，积极局部治疗比单纯全身治疗具有生存优势。
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