可切除和边界可切除结直肠癌伴肝转移患者术前化疗生存结局的预测因素。

Predictive Factors for the Survival Outcomes of Preoperative Chemotherapy in Patients with Resectable and Borderline Resectable Colorectal Cancer with Liver Metastasis.

机构信息

Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Asian Pac J Cancer Prev. 2023 Sep 1;24(9):3037-3047. doi: 10.31557/APJCP.2023.24.9.3037.

DOI:10.31557/APJCP.2023.24.9.3037

PMID:37774055

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10762754/

Abstract

BACKGROUND

Preoperative chemotherapy increases resectability in borderline resectable colorectal liver metastasis (CRLM) patients who undergo curative liver surgery. Most clinical risk scores and other predictive factors for survival have been extensively studied in patients who undergo upfront liver surgery. However, predictive factors of CRLM patients who received preoperative chemotherapy remains controversial.

METHODS

CRLM patients who received preoperative systemic therapy followed by curative liver surgery at our institution between 1/2012 and 12/2018 were included. This study aimed to investigate factors that predicted the outcomes of preoperative systemic treatment, optimal dose/duration, and toxicity in patients with CRLM.

OUTCOMES

Ninety-eight patients were eligible for analysis. Most patients received oxaliplatin-based chemotherapy (72.7%), while 15.9% received both oxaliplatin and irinotecan. Biologic agents were administered in 48.9% of patients. Overall, chemotherapy-induced liver injury was observed in 38.5%. The median disease-free survival (DFS) and overall survival (OS) were 8.7 months and 3.6 years, respectively. Baseline, pre-surgery, and increased Fong scores after preoperative chemotherapy were significantly associated with DFS and OS. In multivariate analysis, a high Fong score at baseline (p=0.018) was significantly associated with shorter DFS, whereas male sex (p=0.040) and liver surgery (p=0.044) were related to longer OS.

CONCLUSION

In our study, Fong clinical risk scores, female sex, and liver surgery as a part of liver-directed therapy were independent prognostic factors for survival in CRLM patients who received preoperative chemotherapy. These clinical factors should be considered as an option to guide physicians' decisions in selecting patients with CRLM who may benefit most from curative liver-directed therapy.

摘要

背景

术前化疗可提高行根治性肝切除术的边界可切除结直肠肝转移（CRLM）患者的可切除性。大多数临床风险评分和其他用于预测生存的因素已在接受直接肝切除术的患者中进行了广泛研究。然而，接受术前化疗的 CRLM 患者的预测因素仍存在争议。

方法

本研究纳入了 2012 年 1 月至 2018 年 12 月期间在我院接受术前系统治疗后行根治性肝切除术的 CRLM 患者。本研究旨在探讨预测 CRLM 患者术前系统治疗结局、最佳剂量/持续时间和毒性的因素。

结果

98 例患者符合分析条件。大多数患者接受了奥沙利铂为基础的化疗（72.7%），而 15.9%的患者接受了奥沙利铂和伊立替康联合治疗。48.9%的患者接受了生物制剂治疗。总体而言，38.5%的患者发生了化疗相关性肝损伤。中位无疾病生存期（DFS）和总生存期（OS）分别为 8.7 个月和 3.6 年。基线、术前和术前化疗后 Fong 评分升高与 DFS 和 OS 显著相关。多变量分析显示，基线时高 Fong 评分（p=0.018）与较短的 DFS 显著相关，而男性（p=0.040）和肝脏手术（p=0.044）与较长的 OS 相关。