Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
J Gastrointest Cancer. 2024 Dec;55(4):1559-1568. doi: 10.1007/s12029-024-01105-8. Epub 2024 Aug 22.
Our study aims to determine the predictors and patterns of relapses after curative colorectal liver metastasis (CRLM) resection.
A single-centre, retrospective study of CRLM patients operated between 2010 and 2022 was performed. The site of first recurrence was either hepatic (marginal (≤ 1 cm) or extramarginal), extrahepatic, or both. Factors that predicted relapse patterns and overall survival were determined by multivariable Cox regression analysis with backward elimination of variables.
The study consisted of 258 patients, with a similar proportion of synchronous (144; 56%) and metachronous(114; 43%) metastasis. At a 43-month median follow-up, 156 patients (60.4%) developed recurrences with 33 (21.1%) in the liver, 62(24.03%) extra-hepatic recurrences, and 58 (22.48%) having both. Isolated marginal liver relapses were seen in seven (9.89%) liver recurrence patients. The median overall and relapse-free survivals were 38 months (30-54) and 13 months (11-16), respectively. The 3-year liver-relapse-free survival was 54.4% (44.9-60.6). Size of liver metastases > 5 cm (HR 2.06 (1.34-3.17), involved surgical margins (HR 2.16 (1.27-3.68)), and adjuvant chemotherapy (HR 1.89 (1.07-3.35)) were predictors of hepatic recurrences. Node positivity of primary (HR 1.61 (1.02-2.56)), presence of baseline extra-hepatic metastases (HR 0.30 (0.18-0.51)), size of liver metastases > 5 cm (HR 2.02 (1.37-2.99)), poorly differentiated histology (HR 2.25 (1.28-3.49)), presence of LVI (HR 2.25 (1.28-3.94)), and adjuvant chemotherapy (HR 2.15 (1.28-3.61)) were predictors of extra-hepatic recurrences.
The study found majority relapses occurred at extrahepatic sites whilst isolated marginal recurrences were few. The consistent predictors of recurrence were size and inability to deliver adjuvant therapy. A tailored adjuvant therapy might improve outcomes after liver metastasectomy in colorectal cancers.
本研究旨在确定结直肠癌肝转移（CRLM）切除术后治愈患者复发的预测因素和模式。
对 2010 年至 2022 年间接受 CRLM 手术的单中心回顾性研究患者进行了研究。首次复发部位为肝内（边缘（≤1cm）或肝外）、肝外或两者兼有。通过多变量 Cox 回归分析和变量向后消除，确定预测复发模式和总生存的因素。
该研究共纳入 258 例患者，其中同步（144 例；56%）和异时性（114 例；43%）转移的比例相似。在中位随访 43 个月时，156 例患者（60.4%）出现复发，其中 33 例（21.1%）发生肝内复发，62 例（24.03%）发生肝外复发，58 例（22.48%）同时发生肝内和肝外复发。在 33 例肝内复发患者中，有 7 例（9.89%）为孤立性边缘肝复发。中位总生存期和无复发生存期分别为 38 个月（30-54）和 13 个月（11-16）。3 年肝无复发生存率为 54.4%（44.9-60.6）。肝转移灶直径＞5cm（HR 2.06（1.34-3.17））、手术切缘受累（HR 2.16（1.27-3.68））和辅助化疗（HR 1.89（1.07-3.35））是肝复发的预测因素。原发灶淋巴结阳性（HR 1.61（1.02-2.56））、基线存在肝外转移（HR 0.30（0.18-0.51））、肝转移灶直径＞5cm（HR 2.02（1.37-2.99））、低分化组织学（HR 2.25（1.28-3.49））、存在血管侵犯（HR 2.25（1.28-3.94））和辅助化疗（HR 2.15（1.28-3.61））是肝外复发的预测因素。
本研究发现大多数复发发生在肝外部位，而孤立性边缘复发较少。复发的一致预测因素是肿瘤大小和无法进行辅助治疗。针对特定患者的辅助治疗可能会改善结直肠癌肝转移切除术后的预后。
