新辅助治疗后总转移灶体积及相对体积缩小可预测结直肠癌肝转移肝切除术后的预后。

Total Metastases Volume and Relative Volume Reduction After Neoadjuvant Therapy Predict Outcome After Liver Resection of Colorectal Liver Metastases.

作者信息

Lindenlaub Florian, Asenbaum Ulrika, Schwarz Christoph, Makolli Jessica, Mittlböck Martina, Stremitzer Stefan, Kaczirek Klaus

机构信息

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

Department of General Surgery, Medical University of Vienna, Vienna, Austria.

出版信息

Ann Surg Oncol. 2025 Aug;32(8):5667-5674. doi: 10.1245/s10434-025-17295-9. Epub 2025 Apr 24.

DOI:10.1245/s10434-025-17295-9

PMID:40274707

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12222231/

Abstract

BACKGROUND

Established clinical risk scores (CRSs) can estimate the prognosis of patients with colorectal liver metastases (CLM) after hepatic resection. However, their ability to predict outcome for patients undergoing neoadjuvant chemotherapy is limited, mainly because most included variables do not reflect a biologic response to neoadjuvant chemotherapy (NAC). This study aimed to evaluate the prognostic value of total metastases volume (TMV) and relative volume reduction (RVR) for patients with CLM undergoing perioperative chemotherapy and surgery.

METHODS

Liver metastases volume was semi-automatically measured on computed tomography images in 69 patients before and after NAC and compared to established CRS regarding progression-free survival (PFS) and overall survival (OS).

RESULTS

Patients with a TMV smaller than 29.5 ml before NAC and 7.5 ml after NAC showed a significantly longer PFS than those with a larger TMV (median, 31.0 vs. 13.7 months [p = 0.005] and 22.6 vs. 9.1 months [p = 0.013], respectively). An RVR after NAC of at least 73% was a positive predictor of PFS (median, 38.0 vs. 9.4 months; p = 0.004) and OS (mean, 59.5 vs. 92.5 months; p = 0.002).

CONCLUSIONS

Total tumor volume and RVR of CLM seem to be superior to established CRS for patients undergoing neoadjuvant chemotherapy and surgery.

摘要

背景

已建立的临床风险评分（CRS）可以估计肝切除术后结直肠癌肝转移（CLM）患者的预后。然而，它们预测接受新辅助化疗患者预后的能力有限，主要是因为大多数纳入的变量不能反映对新辅助化疗（NAC）的生物学反应。本研究旨在评估总转移瘤体积（TMV）和相对体积缩小（RVR）对接受围手术期化疗和手术的CLM患者的预后价值。

方法

在69例患者接受NAC前后，通过计算机断层扫描图像半自动测量肝转移瘤体积，并与已建立的CRS在无进展生存期（PFS）和总生存期（OS）方面进行比较。

结果

NAC前TMV小于29.5 ml且NAC后小于7.5 ml的患者，其PFS显著长于TMV较大的患者（中位数分别为31.0 vs. 13.7个月[p = 0.005]和22.6 vs. 9.1个月[p = 0.013]）。NAC后RVR至少为73%是PFS（中位数，38.0 vs. 9.4个月；p = 0.004）和OS（均值，59.5 vs. 92.5个月；p = 0.002）的阳性预测指标。