Ninomiya Mizuki, Itoh Shinji, Takeishi Kazuki, Toshima Takeo, Yoshiya Shohei, Morita Kazutoyo, Minagawa Ryosuke, Iguchi Tomohiro, Oki Eiji, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
Department of Surgery, Aso Iizuka Hospital, Fukuoka, Japan.
Surg Today. 2025 Mar;55(3):425-433. doi: 10.1007/s00595-024-02920-z. Epub 2024 Aug 19.
We aimed to define borderline resectable colorectal liver metastases (CRLM) based on the analysis of risk factors for early surgical failure and investigate the efficacy of neoadjuvant chemotherapy in these patients.
This was a retrospective analysis of a multi-institutional cohort of patients diagnosed with technically resectable CRLM. Early surgical failure within 6 months of liver surgery was defined as ESF6. We classified CRLM into three grades (A, B, and C) according to the definition of the Japanese Society for Cancer of the Colon and Rectum.
Among the 249 patients with technically resectable CRLM, 46 (18.5%) developed ESF6. The survival rate of these patients was significantly lower than that of the patients without ESF6. In the multivariate analysis of synchronous CRLM patients, no neoadjuvant chemotherapy, Grade B/C, and Charlson comorbidity index ≥ 3 were independent predictors of ESF6. Among patients with synchronous and Grade B/C CRLM, ESF6 rates, surgical failure-free survival, and overall survival in the neoadjuvant chemotherapy group were significantly better relative to the upfront surgery group.
Patients with synchronous and Grade B/C CRLM are at a high risk of early surgical failure, have a poor long-term prognosis, and can be defined as borderline resectable and good candidates for neoadjuvant chemotherapy.
我们旨在通过分析早期手术失败的危险因素来定义可切除边缘的结直肠癌肝转移（CRLM），并研究新辅助化疗在这些患者中的疗效。
这是一项对诊断为技术上可切除的CRLM患者的多机构队列进行的回顾性分析。肝手术后6个月内的早期手术失败定义为ESF6。根据日本结直肠癌学会的定义，我们将CRLM分为三个等级（A、B和C）。
在249例技术上可切除的CRLM患者中，46例（18.5%）发生了ESF6。这些患者的生存率显著低于没有发生ESF6的患者。在同步性CRLM患者的多因素分析中，未进行新辅助化疗、B/C级以及Charlson合并症指数≥3是ESF6的独立预测因素。在同步性和B/C级CRLM患者中，新辅助化疗组的ESF6发生率、无手术失败生存率和总生存率相对于直接手术组均显著更好。
同步性和B/C级CRLM患者早期手术失败风险高，长期预后差，可被定义为可切除边缘，是新辅助化疗的良好候选者。
