Kobayashi Kosuke, Inoue Yosuke, Oba Atsushi, Ono Yoshihiro, Osumi Hiroki, Sato Takafumi, Ito Hiromichi, Mise Yoshihiro, Shinozaki Eiji, Yamaguchi Kensei, Saiura Akio, Takahashi Yu
Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg Oncol. 2025 Mar;32(3):1729-1741. doi: 10.1245/s10434-024-16491-3. Epub 2024 Nov 23.
Colorectal liver metastasis (CLM) is classified into technical and oncologic categories, with recommended treatments for each resectability category. However, the classification of recurrent CLM has not been established to date.
This study evaluated patients with CLM who underwent initial liver resection between 2006 and 2020 and subsequently experienced liver recurrence. Long-term outcomes and prognostic factors associated with recurrent CLM were investigated.
From 949 patients who underwent an initial liver resection, the analysis included 392 patients with liver recurrence. Repeat liver resection was associated with a significantly longer prognosis than non-resection (5-year overall survival [OS] from initial liver resection: 66.3 % vs 27.2 %, p < 0.0001). Multivariable analysis indicated the following independent prognostic factors: four or more recurrent tumors (p = 0.015), tumor 5 cm or larger in size (p = 0.004), and presence of extrahepatic diseases (p = 0.003). The patients were stratified into resectable, borderline resectable, and unresectable recurrent CLM groups based on these criteria. The prognosis varied significantly across the groups, with 5-year OS rates of 67.3 % for resectable recurrent CLM, 30.8 % for borderline resectable recurrent CLM, and 2.6 % for unresectable recurrent CLM (p < 0.0001). Patients with borderline resectable recurrent CLM who did not receive adjuvant chemotherapy after initial liver resection had a positive prognostic impact of preoperative chemotherapy (p = 0.049).
The significant independent predictors of recurrent CLM prognosis were four or more tumors, tumor size of 5 cm or larger, and the presence of extrahepatic diseases at recurrence. It is critical to onsider the current condition and tumor resectability at the time of recurrence, and tailored treatments could further improve recurrent CLM outcomes.
结直肠癌肝转移（CLM）分为技术和肿瘤学类别，且针对每个可切除性类别都有推荐的治疗方法。然而，复发性CLM的分类至今尚未确立。
本研究评估了2006年至2020年间接受初次肝切除且随后出现肝复发的CLM患者。对与复发性CLM相关的长期结局和预后因素进行了调查。
在949例接受初次肝切除的患者中，分析纳入了392例肝复发患者。再次肝切除与比未切除显著更长的预后相关（从初次肝切除起的5年总生存率[OS]：66.3%对27.2%，p<0.0001）。多变量分析表明以下为独立的预后因素：四个或更多复发性肿瘤（p=0.015）、肿瘤大小为5厘米或更大（p=0.004）以及存在肝外疾病（p=0.003）。根据这些标准，将患者分层为可切除、边缘可切除和不可切除的复发性CLM组。各组的预后差异显著，可切除复发性CLM的5年OS率为67.3%，边缘可切除复发性CLM为30.8%，不可切除复发性CLM为2.6%（p<0.0001）。初次肝切除后未接受辅助化疗的边缘可切除复发性CLM患者，术前化疗具有积极的预后影响（p=0.049）。
复发性CLM预后的显著独立预测因素为四个或更多肿瘤、肿瘤大小为5厘米或更大以及复发时存在肝外疾病。复发时考虑当前状况和肿瘤可切除性至关重要，且量身定制的治疗可进一步改善复发性CLM的结局。
