Kung Heng-Chung, Shubert Christopher, Wilbur Catherine, Burns Will, Burkhart Richard, Hidalgo Madison, Azad Nilofer S, Lee Valerie, Chung Haniee, Le Dung T, Laheru Daniel, He Jin, Zheng Lei, Jaffee Elizabeth M, Lafaro Kelly, Tsai Hua-Ling, Christenson Eric S
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
The Cancer Convergence Institute at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Surgery, Johns Hopkins University, Baltimore, MD, United States.
J Gastrointest Surg. 2024 Dec;28(12):2031-2038. doi: 10.1016/j.gassur.2024.09.026. Epub 2024 Oct 3.
Improved surgical techniques and more intensive systemic therapy have increased the number of patients with oligometastatic colorectal cancer eligible for resection, but a significant percentage of these cases will ultimately recur. Furthermore, distinct recurrence patterns have been associated with different outcomes.
Data for 195 patients who underwent curative-intent colorectal liver metastasis (CRLM) resection between 2016 and 2022 at Johns Hopkins Hospital were retrospectively collected. Cox regression univariate and multivariate analyses identified features associated with survival outcomes. Association between risk factors and site of recurrences was conducted via logistic regression with initial recurrences grouped into intrahepatic-only, extrahepatic-only, and concurrent intra- and extrahepatic recurrence.
The 1- and 2-year recurrence-free survival (RFS) rates were 46% and 22%, respectively. The 1- and 2-year overall survival (OS) rates were 95% and 88%, respectively. The median OS was 71.7 months. Multivariate analysis identified age <60 years, N2 nodal status, R1 liver margin, and higher preoperative carcinoembryonic antigen as top prognostic factors for worse RFS. Additionally, patients with left-sided primary tumors had a higher risk of intrahepatic-only recurrence, whereas mutant KRAS was associated with a higher risk of extrahepatic recurrence with or without liver recurrence.
These results from a recent cohort of patients treated with current standard-of-care therapies identify features associated with elevated risk and specific patterns of recurrence. These insights into CRLM recurrence patterns support a larger prospective study to identify subgroups of patients who may require additional therapies to prevent recurrence.
改进的手术技术和更强化的全身治疗增加了适合切除的寡转移性结直肠癌患者数量，但这些病例中有很大一部分最终会复发。此外，不同的复发模式与不同的结局相关。
回顾性收集了2016年至2022年在约翰霍普金斯医院接受根治性结直肠癌肝转移（CRLM）切除术的195例患者的数据。Cox回归单因素和多因素分析确定了与生存结局相关的特征。通过逻辑回归分析危险因素与复发部位之间的关联，将初始复发分为仅肝内复发、仅肝外复发以及同时肝内和肝外复发。
1年和2年无复发生存率（RFS）分别为46%和22%。1年和2年总生存率（OS）分别为95%和88%。中位总生存期为71.7个月。多因素分析确定年龄<60岁、N2淋巴结状态、R1切缘以及术前癌胚抗原水平较高是RFS较差的主要预后因素。此外，左侧原发性肿瘤患者仅肝内复发的风险较高，而KRAS突变与肝外复发（无论有无肝内复发）的风险较高相关。
近期一组接受当前标准治疗的患者的这些结果确定了与风险升高和特定复发模式相关的特征。这些对CRLM复发模式的见解支持开展一项更大规模的前瞻性研究，以确定可能需要额外治疗以预防复发的患者亚组。
