Inoue Akira, Nishizawa Yujiro, Hashimoto Masahiro, Ozato Yuki, Morimoto Yoshihiro, Tomokuni Akira, Motoori Masaaki, Fujitani Kazumasa
Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan.
World J Surg Oncol. 2024 Dec 20;22(1):343. doi: 10.1186/s12957-024-03631-y.
The survival benefit of adjuvant chemotherapy after curative hepatectomy for colorectal cancer (CRC) liver metastases remains controversial. This retrospective study aimed to evaluate the efficacy of adjuvant chemotherapy in improving recurrence-free survival (RFS) and overall survival (OS) in patients who underwent curative hepatectomy for CRC liver metastases at a tertiary medical center.
We retrospectively analyzed clinicopathological factors in 89 patients (surgery alone, n = 63; adjuvant chemotherapy, n = 26) who underwent curative hepatectomy for CRC liver metastases from January 2010 to December 2022. Patients who received neoadjuvant therapy or prior hepatectomy were excluded to minimize patient heterogeneity. Multivariate analysis using Cox proportional hazards regression was conducted to assess the independent effect of adjuvant therapy on RFS and OS.
The 3-year RFS rates were 22.6% in the surgery alone group and 29.6% in the adjuvant chemotherapy group (hazard ratio, 0.71; 95% confidence interval, 0.43-1.21; p = 0.102). The 3-year OS rates were 72.3% in the surgery alone group and 88.5% in the adjuvant chemotherapy group (hazard ratio, 0.59; 95% confidence interval, 0.29-1.25; p = 0.17). Univariate analyses showed that the number of liver metastases (> 2) was significantly associated with poorer OS (hazard ratio, 2.44; 95% confidence interval, 1.11-5.37; p = 0.027). Additionally, multivariate analyses showed that the addition of adjuvant chemotherapy was significantly associated with improved OS (hazard ratio, 0.23; 95% confidence interval, 0.07-0.81; p = 0.021).
Adjuvant chemotherapy may improve OS after curative hepatectomy for CRC liver metastases, though it did not significantly impact RFS. Larger-scale multicenter prospective studies with stratified analyses are needed to confirm these findings.
结直肠癌（CRC）肝转移患者行根治性肝切除术后辅助化疗的生存获益仍存在争议。本回顾性研究旨在评估在一家三级医疗中心接受CRC肝转移根治性肝切除术的患者中，辅助化疗在改善无复发生存期（RFS）和总生存期（OS）方面的疗效。
我们回顾性分析了2010年1月至2022年12月期间89例行CRC肝转移根治性肝切除术的患者的临床病理因素（单纯手术组，n = 63；辅助化疗组，n = 26）。排除接受新辅助治疗或既往有肝切除术的患者，以尽量减少患者异质性。采用Cox比例风险回归进行多因素分析，以评估辅助治疗对RFS和OS的独立影响。
单纯手术组的3年RFS率为22.6%，辅助化疗组为29.6%（风险比，0.71；95%置信区间，0.43 - 1.21；p = 0.102）。单纯手术组的3年OS率为72.3%，辅助化疗组为88.5%（风险比，0.59；95%置信区间，0.29 - 1.25；p = 0.17）。单因素分析显示，肝转移灶数量（> 2个）与较差的OS显著相关（风险比，2.44；95%置信区间，1.11 - 5.37；p = 0.027）。此外，多因素分析显示，辅助化疗的加入与OS改善显著相关（风险比，0.23；95%置信区间，0.07 - 0.81；p = 0.021）。
辅助化疗可能改善CRC肝转移根治性肝切除术后的OS，尽管对RFS无显著影响。需要开展更大规模的多中心前瞻性分层分析研究来证实这些发现。
