Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States.
Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, United States; Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, United States.
J Gastrointest Surg. 2024 Mar;28(3):246-251. doi: 10.1016/j.gassur.2023.12.026. Epub 2024 Jan 19.
Despite significant advancements in the treatment of patients with colorectal liver metastases (CRLMs), only a minority will experience long-term survival. This study aimed to determine the effect of chemotherapy (CT) and immunotherapy (IT) compared with that of CT alone on patient survival after surgical resection.
Patients undergoing curative-intent liver resection followed by adjuvant systemic therapy for stage IV colon cancer were identified using the National Cancer Database. Patients were stratified into type of therapy (CT alone vs CT + IT) and microsatellite status. Propensity score-weighted analysis was performed through 1:1 matching based on the nearest neighbor method.
Of 9943 patients who underwent resection of CRLMs, 7971 (80%) received systemic adjuvant therapy. Of 7971 patients, 1432 (18%) received a combination of CT and IT. Microsatellite status was not associated with overall survival (OS). Adjuvant CT + IT was associated with increased 3-year OS compared with that of CT alone in both the unmatched cohort (55% vs 48%, respectively; P < .001) and matched cohort (52% vs 48%, respectively; P = .050). On multivariate analysis, older age, positive resection margins, and KRAS mutation were independent predictors of poor survival, whereas the administration of adjuvant CT + IT was an independent predictor of improved survival.
IT combined with CT was associated with improved survival compared with that of CT alone after curative-intent resection of CRLMs, regardless of microsatellite instability status. Clinical trials to determine optimal patient selection, IT regimen, and long-term efficacy to improve outcomes of patients with CRLMs are warranted.
尽管在治疗结直肠癌肝转移（CRLM）患者方面取得了重大进展，但只有少数患者能长期生存。本研究旨在确定与单独化疗（CT）相比，化疗（CT）联合免疫治疗（IT）对接受根治性肝切除术后患者的生存影响。
本研究使用国家癌症数据库（National Cancer Database）确定了接受根治性肝切除术后接受辅助全身治疗的 IV 期结肠癌患者。患者根据治疗方式（单独 CT 治疗与 CT + IT 联合治疗）和微卫星状态进行分层。采用最近邻匹配的 1:1 倾向评分加权分析。
在 9943 例接受 CRLM 切除的患者中，7971 例（80%）接受了系统辅助治疗。在 7971 例患者中，1432 例（18%）接受了 CT 联合 IT 联合治疗。微卫星状态与总生存（OS）无关。与单独 CT 治疗相比，辅助 CT + IT 治疗在未匹配队列（分别为 55%和 48%；P<0.001）和匹配队列（分别为 52%和 48%；P=0.050）中均显著提高了 3 年 OS。多因素分析显示，年龄较大、切缘阳性和 KRAS 突变是生存不良的独立预测因素，而辅助 CT + IT 治疗是生存改善的独立预测因素。
与单独 CT 治疗相比，在根治性切除 CRLM 后，无论微卫星不稳定状态如何，联合 CT 治疗的 IT 治疗均能提高生存率。需要进行临床试验以确定最佳患者选择、IT 方案以及提高 CRLM 患者长期疗效的方法。
