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局部治疗可改善结直肠癌肝转移切除术后早期复发患者的生存。

Local Therapy Improves Survival for Early Recurrence After Resection of Colorectal Liver Metastases.

机构信息

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.

出版信息

Ann Surg Oncol. 2024 Apr;31(4):2547-2556. doi: 10.1245/s10434-023-14806-4. Epub 2023 Dec 27.


DOI:10.1245/s10434-023-14806-4
PMID:38148351
Abstract

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.

摘要

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。

相似文献

[1]
Local Therapy Improves Survival for Early Recurrence After Resection of Colorectal Liver Metastases.

Ann Surg Oncol. 2024-4

[2]
Effect of Co-mutation of RAS and TP53 on Postoperative ctDNA Detection and Early Recurrence after Hepatectomy for Colorectal Liver Metastases.

J Am Coll Surg. 2022-4-1

[3]
Neither Surgical Margin Status nor Somatic Mutation Predicts Local Recurrence After R0-intent Resection for Colorectal Liver Metastases.

J Gastrointest Surg. 2022-4

[4]
RAS mutation status predicts survival and patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases.

Ann Surg. 2013-10

[5]
Conditional Recurrence-Free Survival after Resection of Colorectal Liver Metastases: Persistent Deleterious Association with RAS and TP53 Co-Mutation.

J Am Coll Surg. 2019-5-2

[6]
RAS Mutation is Associated with Unsalvageable Recurrence Following Hepatectomy for Colorectal Cancer Liver Metastases.

Ann Surg Oncol. 2018-5-21

[7]
KRAS Mutation Status Predicts Site-Specific Recurrence and Survival After Resection of Colorectal Liver Metastases Irrespective of Location of the Primary Lesion.

Ann Surg Oncol. 2016-6

[8]
Codon 13 KRAS mutation predicts patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases.

Cancer. 2016-5-31

[9]
Prognostic factors after resection of colorectal liver metastases following preoperative second-line chemotherapy: Impact of RAS mutations.

Eur J Surg Oncol. 2016-9

[10]
SMAD4 gene mutation predicts poor prognosis in patients undergoing resection for colorectal liver metastases.

Eur J Surg Oncol. 2018-3-7

引用本文的文献

[1]
Laparoscopic resection combined with ablation for multiple colorectal liver metastases: a multicentre propensity-matched analysis.

Surg Endosc. 2025-8-13

[2]
Validation of tumor burden score as a prognostic factor in colorectal cancer liver metastases patients: a retrospective analysis.

J Gastrointest Cancer. 2025-5-14

[3]
Recurrent Colorectal Liver Metastases: Opportunities for Biology-Informed Surgery Beyond Initial Hepatectomy.

Ann Surg Oncol. 2025-3

[4]
Strategies for Recurrent Colorectal Liver Metastases Based on Prognostic Factors and Resectability: Potential Benefit of Multidisciplinary Treatment.

Ann Surg Oncol. 2025-3

[5]
CEA Rebound After Discontinuation of Pre-Hepatectomy Chemotherapy Predicts Worse Outcomes After Resection of Colorectal Cancer Liver Metastases.

Ann Surg Oncol. 2025-2

[6]
Establishment of nomogram to predict overall survival and cancer-specific survival of local tumor resection in patients with colorectal cancer liver metastasis with unresectable metastases: a large population-based analysis.

Discov Oncol. 2024-7-29

[7]
ASO Author Reflections: Patients with Recurrence Amenable to Local Therapy for Colorectal Liver Metastases May Experience Improved Survival.

Ann Surg Oncol. 2024-4

本文引用的文献

[1]
Colorectal Liver Micrometastases: Association with RAS/TP53 Co-Mutation and Prognosis after Surgery.

J Am Coll Surg. 2022-7-1

[2]
Preventing Futile Liver Resection: A Risk-Based Approach to Surgical Selection in Major Hepatectomy for Colorectal Cancer.

Ann Surg Oncol. 2022-2

[3]
Survival Benefit of Repeat Local Treatment in Patients Suffering From Early Recurrence of Colorectal Cancer Liver Metastases.

Clin Colorectal Cancer. 2021-12

[4]
Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection.

BMC Surg. 2021-8-16

[5]
Repeat hepatectomy justified in patients with early recurrence of colorectal cancer liver metastases: A systematic review and meta-analysis.

Cancer Epidemiol. 2021-10

[6]
Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer.

J Am Coll Surg. 2021-8

[7]
Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival.

Surgery. 2021-5

[8]
RAS/TP53 Co-mutation is Associated With Worse Survival After Concurrent Resection of Colorectal Liver Metastases and Extrahepatic Disease.

Ann Surg. 2022-8-1

[9]
Stereotactic radiofrequency ablation (SRFA) for recurrent colorectal liver metastases after hepatic resection.

Eur J Surg Oncol. 2021-4

[10]
A new sequential treatment strategy for multiple colorectal liver metastases: Planned incomplete resection and postoperative completion ablation for intentionally-untreated tumors under guidance of cross-sectional imaging.

Eur J Surg Oncol. 2021-2

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