采用门静脉栓塞术的两阶段肝切除术治疗结直肠癌肝转移的评估：日本一项全国性回顾性队列研究
Evaluation of two-stage hepatectomy using portal vein embolization for colorectal liver metastasis: a retrospective nationwide cohort survey in Japan.
作者信息
Shimizu Takayuki, Aoki Taku, Ishizuka Mitsuru, Sakamoto Katsunori, Beppu Toru, Honda Goro, Kotake Kenjiro, Yamamoto Masakazu, Takahashi Keiichi, Endo Itaru, Hasegawa Kiyoshi, Itabashi Michio, Hashiguchi Yojiro, Kotera Yoshihito, Kobayashi Shin, Yamaguchi Tatsuro, Natsume Soichiro, Tabuchi Ken, Kobayashi Hirotoshi, Yamaguchi Kensei, Tani Kimitaka, Morita Satoshi, Miyazaki Masaru, Sugihara Kenichi, Ajioka Yoichi
机构信息
Joint Committee for National Survey on Colorectal Liver Metastasis, Tokyo.
Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi.
出版信息
Int J Surg. 2024 Oct 1;110(10):6691-6701. doi: 10.1097/JS9.0000000000001811.
INTRODUCTION
Two-stage hepatectomy (TSH) enables patients to undergo surgery for colorectal liver metastasis (CRLM), which one-stage hepatectomy cannot remove. Although the outcome of TSH has been reported, there is no original report from Japan. The aim of this retrospective study was to evaluate the outcome of TSH in Japanese patients with CRLM.
METHODS
The authors conducted a retrospective cohort study using the nationwide database that included clinical information of 12 519 patients treated with CRLM between 2005 and 2017 in Japan. The primary outcome measure was overall survival. The second outcome measure was progression-free survival. Fisher's exact test, χ 2 test and Mann-Whitney U test were conducted to examine an intergroup difference. Univariate and multivariate analyses were performed using Cox regression model. Survival analysis was performed by Kaplan-Meier method and log-rank test.
RESULTS
Of the database, 53 patients undergoing TSH using portal vein embolization (PVE) were identified and analyzed. Their morbidity and in-hospital mortality rates at the second hepatectomy were 26.4% and 0.0%. The mean observation period was 21.8 months. The estimated 1-, 3- and 5-year overall survival rate were 92.5%, 70.8% and 34.7%. Multivariate analyses showed that more than 10 liver nodules significantly increased the mortality risk by 4.2-fold (95% CI 1.224-14.99, P = 0.023). Survival analysis revealed that repeat hepatectomy for disease progression after TSH was superior to chemotherapy in overall survival (mean: 49.6 vs. 18.7, months, P = 0.004).
CONCLUSION
In the Japanese cohort, TSH was confirmed to be a safety procedure with an acceptable survival outcome. More than 10 liver nodules may be a predictor for unfavorable outcomes of patients with CRLM undergoing TSH. Furthermore, repeat hepatectomy can be a salvage treatment for resectable intrahepatic recurrence after TSH.
引言
两阶段肝切除术（TSH）使患者能够接受手术治疗无法通过一期肝切除术切除的结直肠癌肝转移（CRLM）。尽管已有关于TSH治疗结果的报道，但日本尚无原始报告。这项回顾性研究的目的是评估日本CRLM患者接受TSH的治疗结果。
方法
作者使用全国性数据库进行了一项回顾性队列研究，该数据库包含2005年至2017年在日本接受CRLM治疗的12519例患者的临床信息。主要结局指标是总生存期。第二个结局指标是无进展生存期。采用Fisher精确检验、χ²检验和Mann-Whitney U检验来检验组间差异。使用Cox回归模型进行单因素和多因素分析。采用Kaplan-Meier法和对数秩检验进行生存分析。
结果
在数据库中，识别并分析了53例接受门静脉栓塞（PVE）的TSH患者。他们在第二次肝切除时的发病率和住院死亡率分别为26.4%和0.0%。平均观察期为21.8个月。估计的1年、3年和5年总生存率分别为92.5%、70.8%和34.7%。多因素分析显示，超过10个肝结节使死亡风险显著增加4.2倍（95%CI 1.224-14.99，P = 0.023）。生存分析显示，TSH后因疾病进展而进行的再次肝切除术在总生存期方面优于化疗（平均：49.6个月对18.7个月，P = 0.004）。
结论
在日本队列中，TSH被证实是一种安全的手术，生存结局可以接受。超过10个肝结节可能是接受TSH的CRLM患者不良结局的一个预测因素。此外，再次肝切除术可以作为TSH后可切除肝内复发的挽救性治疗。
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