Zhong Wenhui, Xu Bowen, Lu Yiming, Chang Jianping, Xu Lin, Zhao Hong, Che Xu
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Gastroenterol Hepatol. 2024 May;39(5):908-919. doi: 10.1111/jgh.16504. Epub 2024 Feb 7.
A growing number of studies have demonstrated that neoadjuvant chemotherapy can improve the prognosis of patients with resectable colorectal liver metastases (CRLM). However, the routine use of postoperative adjuvant chemotherapy (POAC) for patients with CRLM after simultaneous resection remains controversial. This retrospective study investigated the impact of POAC on outcomes in patients with CRLM who underwent simultaneous resection of colorectal cancer tumors and liver metastases using propensity score matching (PSM) analysis.
From January 2009 to November 2020, patients with CRLM who underwent simultaneous resection were retrospectively enrolled. The confounding factors and selection bias were adjusted by 2:1 PSM. Patients were stratified into the POAC and non-POAC groups. Kaplan-Meier curves were utilized to compare overall survival (OS) and progression-free survival (PFS) between the groups. Univariate and multivariate Cox regression analyses were used to identify independent clinicopathological factors before and after PSM analysis. The utility of the model was evaluated using receiver operating characteristic (ROC) and calibration curves after PSM analysis.
In total, 478 patients with resectable CRLM were enrolled and assigned to the POAC (n = 212, 60.9%) or non-POAC group (n = 136, 39.1%). After 2:1 PSM, there was no significant bias between the groups. Kaplan-Meier survival analysis revealed a significant effect of POAC on OS (P < 0.001) but not PFS. Multivariate Cox regression analysis identified T stage (T3-T4), lymph node metastasis, radiofrequency ablation during surgery, operative time ≥ 325 min, and the receipt of postoperative adjuvant chemotherapy (hazard ratio = 0.447, 95% confidence interval = 0.312-0.638, P < 0.001) as independent prognostic factors for OS. The areas under the ROC curves for the nomogram model for predicting 1-, 3-, and 5-year survival were 0.653, 0.628, and 0.678, respectively. Subgroups analysis suggested that POAC can enhance OS in patients with resectable CRLM with either low (1-2, P < 0.001) or high clinical risk scores (3-5, P = 0.020).
Overall, this study identified POAC as a prognostic factor to predict OS in patients with CRLM undergoing simultaneous resection.
越来越多的研究表明，新辅助化疗可改善可切除结直肠癌肝转移（CRLM）患者的预后。然而，对于同时性切除术后的CRLM患者常规使用术后辅助化疗（POAC）仍存在争议。本回顾性研究采用倾向评分匹配（PSM）分析，探讨POAC对同时性切除结直肠癌肿瘤和肝转移的CRLM患者预后的影响。
回顾性纳入2009年1月至2020年11月期间接受同时性切除的CRLM患者。通过2:1的PSM调整混杂因素和选择偏倚。将患者分为POAC组和非POAC组。利用Kaplan-Meier曲线比较两组的总生存期（OS）和无进展生存期（PFS）。采用单因素和多因素Cox回归分析确定PSM分析前后的独立临床病理因素。在PSM分析后，使用受试者工作特征（ROC）曲线和校准曲线评估模型的效用。
共纳入478例可切除的CRLM患者，分为POAC组（n = 212，60.9%）和非POAC组（n = 136，39.1%）。经过2:1的PSM后，两组之间无显著偏倚。Kaplan-Meier生存分析显示POAC对OS有显著影响（P < 0.001），但对PFS无显著影响。多因素Cox回归分析确定T分期（T3-T4）、淋巴结转移、手术中射频消融、手术时间≥325分钟以及接受术后辅助化疗（风险比 = 0.447，95%置信区间 = 0.312-0.638，P < 0.001）为OS的独立预后因素。预测1年、3年和5年生存率的列线图模型的ROC曲线下面积分别为0.653、0.628和0.678。亚组分析表明，POAC可提高低临床风险评分（1-2，P < 0.001）或高临床风险评分（3-5，P = 0.020）的可切除CRLM患者的OS。
总体而言，本研究确定POAC是预测同时性切除的CRLM患者OS的一个预后因素。
