Choi Songji, Kang Minsu, Kim Ji-Won, Kim Jin Won, Jeon Jae Hyun, Oh Heung-Kwon, Lee Hae Won, Cho Jai Young, Kim Duck-Woo, Cho Sukki, Kim Jee Hyun, Kim Kwhanmien, Kang Sung-Bum, Jheon Sanghoon, Lee Keun-Wook
Department of Genomic Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Curr Probl Cancer. 2024 Dec;53:101151. doi: 10.1016/j.currproblcancer.2024.101151. Epub 2024 Oct 22.
Primary tumor resection and metastasectomy are curative for metastatic colorectal cancer. However, there is still a paucity of data regarding the clinical outcomes and risk factors after disease recurrence and second metastasectomy.
We retrospectively evaluated the clinical outcomes of patients who underwent the second metastasectomy. In addition, risk factors for the outcomes were analyzed.
A total of 94 patients (39 females and 55 males) received a second metastasectomy after the recurrence. Recurrent sites included the lung (47 patients), liver (36 patients), both lung and liver (four patients), and non-lung/non-liver (seven patients). Among them, 89 (94.7 %) patients achieved R0 resection, while three (3.2 %) and two (2.1 %) patients achieved R1 and R2 resections, respectively. The 5-year disease-free survival (DFS) and overall survival (OS) were 42.8±5.3 % and 67.2±4.9 %, respectively. Multivariable analysis for DFS identified that primary rectal cancer (hazard ratio [HR] 0.45, P=0.033) and disease-free interval after the first metastasectomy of ≥12 months (HR 0.39, P=0.002) were good predictive factors; in contrast, non-lung/non-liver metastasis (HR 3.32, P=0.020) was a poor predictive factor. Multivariable analysis for OS showed that age ≥70 years (HR 3.27, P=0.011), non-lung/non-liver metastasis (HR 4.04, P=0.024), and lesion number ≥2 (HR 2.25, P=0.023) were poor prognostic factors.
Patients who underwent a second metastasectomy had a long-term disease-free state and good OS. Our data suggest that a second metastasectomy should be considered if a patient has a limited number of metastases confined to the liver and/or lung and long DFS after the first metastasectomy.
原发性肿瘤切除和转移灶切除术可治愈转移性结直肠癌。然而，关于疾病复发和二次转移灶切除术后的临床结局及危险因素的数据仍然匮乏。
我们回顾性评估了接受二次转移灶切除术患者的临床结局。此外，分析了结局的危险因素。
共有94例患者（39例女性和55例男性）在复发后接受了二次转移灶切除术。复发部位包括肺（47例患者）、肝（36例患者）、肺和肝（4例患者）以及非肺/非肝（7例患者）。其中，89例（94.7%）患者实现了R0切除，而3例（3.2%）和2例（2.1%）患者分别实现了R1和R2切除。5年无病生存率（DFS）和总生存率（OS）分别为42.8±5.3%和67.2±4.9%。DFS的多变量分析确定原发性直肠癌（风险比[HR]0.45，P=0.033）和首次转移灶切除术后无病间期≥12个月（HR 0.39，P=0.002）是良好的预测因素；相反，非肺/非肝转移（HR 3.32，P=0.020）是不良预测因素。OS的多变量分析显示年龄≥70岁（HR 3.27，P=0.011）、非肺/非肝转移（HR 4.04，P=0.024）和病灶数≥2（HR 2.25，P=0.023）是不良预后因素。
接受二次转移灶切除术的患者具有长期无病状态和良好的OS。我们的数据表明，如果患者转移灶数量有限且局限于肝和/或肺，并且首次转移灶切除术后DFS长，则应考虑进行二次转移灶切除术。
