Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2024 Apr;31(4):2547-2556. doi: 10.1245/s10434-023-14806-4. Epub 2023 Dec 27.
BACKGROUND: Early recurrence following hepatectomy for colorectal liver metastases (CLM) is associated with worse survival; yet, impact of further local therapy is unclear. We sought to evaluate whether local therapy benefits patients with early recurrence following hepatectomy for CLM. METHODS: Clinicopathologic and survival outcomes of patients managed with hepatectomy for CLM (1/2001-12/2020) were queried from a prospectively maintained database. Timing of recurrence was stratified as early (recurrence-free survival [RFS] < 6 months), intermediate (RFS 6-12 months), and later (RFS > 12 months). Local therapy was defined as ablation, resection, or radiation. RESULTS: Of 671 patients, 541 (81%) recurred with 189 (28%) early, 180 (27%) intermediate, and 172 (26%) later recurrences. Local therapy for recurrence resulted in improved survival, regardless of recurrence timing (early 78 vs. 32 months, intermediate 72 vs. 39 months, later 132 vs. 65 months, all p < 0.001). Following recurrence, treatment with local therapy (hazard ratio [HR] = 0.24), liver and extrahepatic recurrence (HR = 1.81), RAS + TP53 co-mutation (HR = 1.52), and SMAD4 mutation (HR = 1.92) were independently associated with overall survival (all p ≤ 0.002). Among patients with recurrence treated by local therapy, patients older than 65 years (HR 1.79), liver and extrahepatic recurrence (HR 2.05), primary site or other recurrence (HR 1.90), RAS-TP53 co-mutation (HR 1.63), and SMAD4 mutation (HR 2.06) had shorter post-local therapy survival (all p ≤ 0.04). CONCLUSIONS: While most patients recur after hepatectomy for CLM, local therapy may result in long-term survival despite early recurrence. Somatic mutational profiling may help to guide the multidisciplinary consideration of local therapy after recurrence.
背景:肝切除术治疗结直肠肝转移(CLM)后的早期复发与更差的生存相关;然而,进一步局部治疗的影响尚不清楚。我们旨在评估肝切除术治疗 CLM 后早期复发的患者是否能从局部治疗中获益。
方法:从一个前瞻性维护的数据库中查询了 2001 年 1 月至 2020 年 12 月接受 CLM 肝切除术治疗的患者的临床病理和生存结果。复发时间分为早期(无复发生存[RFS]<6 个月)、中期(RFS 6-12 个月)和晚期(RFS>12 个月)。局部治疗定义为消融、切除或放疗。
结果:在 671 例患者中,541 例(81%)发生了复发,其中 189 例(28%)为早期复发,180 例(27%)为中期复发,172 例(26%)为晚期复发。对于复发患者,无论复发时间如何,接受局部治疗均可改善生存(早期 78 与 32 个月,中期 72 与 39 个月,晚期 132 与 65 个月,均 p<0.001)。在复发后,局部治疗(风险比[HR]=0.24)、肝内和肝外复发(HR=1.81)、RAS+TP53 共突变(HR=1.52)和 SMAD4 突变(HR=1.92)与总生存(均 p≤0.002)独立相关。在接受局部治疗的复发患者中,年龄大于 65 岁的患者(HR 1.79)、肝内和肝外复发的患者(HR 2.05)、原发部位或其他部位复发的患者(HR 1.90)、RAS-TP53 共突变的患者(HR 1.63)和 SMAD4 突变的患者(HR 2.06)局部治疗后生存时间更短(均 p≤0.04)。
结论:尽管大多数患者在接受 CLM 肝切除术治疗后会复发,但局部治疗仍可能带来长期生存,即使是在早期复发的情况下。体细胞突变谱分析可能有助于指导复发后局部治疗的多学科考虑。