Department of Surgical Oncology, Scott Bieler Clinical Sciences Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Ann Surg Oncol. 2023 Dec;30(13):7986-7995. doi: 10.1245/s10434-023-14302-9. Epub 2023 Sep 29.
The sequence of localized and systemic treatment for colorectal liver metastases (CRLM) remains debated. Our objective is to analyze the effect of treatment sequence on overall survival (OS) in patients with CRLM using a large cancer database.
The national cancer database (NCDB) was utilized to identify patients with stage IV colorectal cancer (CRC) diagnosed between 2004 and 2016. OS was analyzed using standard univariate and multivariate methods.
We identified 72,376 patients with synchronous CRLM, of whom 43,039 had liver-only metastases. Patients with liver-only CRLM had a median OS of 18.9 months, versus those with CRLM plus extrahepatic sites (11.3 months). In patients with liver-only CRLM, resection of both the primary and metastatic site was associated with median OS 38.9 months versus 30.2 months after resection of the metastatic site alone, and resection of the primary tumor alone (22.3 months, all p < 0.001). Receipt of perioperative chemotherapy correlated with a median OS of 44.7 months versus preoperative chemotherapy only (38.4 months) or postoperative chemotherapy only (27.9 months, all p < 0.001). Patients who received chemotherapy alone had a median OS of 16.4 months versus those who underwent resection without chemotherapy (9.5 months, p < 0.001).
This study reveals a correlation between perioperative chemotherapy and superior OS in patients with liver-only CRLM, and shows that resection of the metastatic site was linked to better OS. Despite obvious cohort heterogeneity, the data can support a resection approach with additional, preferably peri- or preoperative systemic therapy for patients with CRLM.
结直肠癌肝转移（CRLM）的局部和系统治疗顺序仍存在争议。我们的目的是使用大型癌症数据库分析治疗顺序对 CRLM 患者总生存期（OS）的影响。
我们利用国家癌症数据库（NCDB）鉴定了 2004 年至 2016 年间诊断为 IV 期结直肠癌（CRC）的患者。使用标准单变量和多变量方法分析 OS。
我们鉴定了 72376 例同步 CRLM 患者，其中 43039 例患者仅有肝转移。仅有肝转移的 CRLM 患者的中位 OS 为 18.9 个月，而 CRLM 合并肝外部位的患者为 11.3 个月。仅有肝转移的 CRLM 患者，原发灶和转移灶均切除的患者中位 OS 为 38.9 个月，而仅切除转移灶的患者为 30.2 个月，仅切除原发灶的患者为 22.3 个月（均 P<0.001）。接受围手术期化疗的患者中位 OS 为 44.7 个月，而仅术前化疗（38.4 个月）或仅术后化疗（27.9 个月）的患者（均 P<0.001）。单独接受化疗的患者中位 OS 为 16.4 个月，而未接受化疗且行切除术的患者为 9.5 个月（P<0.001）。
本研究揭示了仅有肝转移的 CRLM 患者围手术期化疗与 OS 改善相关，并表明切除转移灶与更好的 OS 相关。尽管存在明显的队列异质性，但这些数据可以支持对 CRLM 患者采用切除方法，并联合辅助性的、最好是围手术期或术前的全身治疗。
