Vitale Alessandro, Lanari Jacopo, Cillo Umberto, Billato Ilaria, Rovetta Alessandro, Mansournia Mohammad Ali, Cescon Matteo, Serenari Matteo, Aucejo Federico, Estfan Bassam, Coubeau Laurent, Iesari Samuele, Mazzaferro Vincenzo, Sposito Carlo, Hernandez-Alejandro Roberto, Tomiyama Koji, Hagness Morten, Dueland Svein, Line Pål Dag
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy.
JHEP Rep. 2025 Jun 27;7(10):101505. doi: 10.1016/j.jhepr.2025.101505. eCollection 2025 Oct.
BACKGROUND & AIMS: Liver transplantation (LT) for colorectal liver metastases (CRLMs) is attracting increasing interest, especially after publication of the TransMet trial. However, multivariable survival analyses are lacking. Here, we performed such an analysis in a multicentre cohort.
We conducted a retrospective multicentre study of 82 patients with CRLMs undergoing LT (from 2006 to 2020) across seven US and European centres, using multivariable Cox, competing-risk models, and extensive sensitivity analyses.
Overall survival rates after 1, 3, and 5 years were 93.7%, 73.4%, and 54.9%, respectively. The findings align with an association between higher risk and the female sex (estimated hazard ratio (HR) 4.1, 95% CI: 1.8-9.2), and the following variables: carcinoembryonic antigen >80 μg/L, right-located colorectal cancer (CRC), largest diameter >5.5 cm, KRAS mutation, and absence of previous liver therapy. Other possible associations with higher uncertainty were pN2-positive CRC and the number of nodules (>10). Variables such as progressive disease after pretransplant chemotherapy and time from primary CRC surgery to LT of ≤24 months, exhibited weaker, less consistent associations.
This first multivariable survival analysis of LT for CRLM suggests that female sex is associated with worse outcomes, whereas the prognostic strength of the model currently used in clinical practice is not confirmed. Our findings challenge current selection criteria, highlighting the need for improved prognostic models with better discrimination and calibration.
This multicentre retrospective study analysed survival outcomes in 82 patients undergoing liver transplantation for colorectal liver metastases across seven US and European centres. Several factors, including female sex, high carcinoembryonic antigen levels, right-sided colorectal cancer, larger tumours, KRAS mutation, pN2-positive CRC, number of nodules, and no prior liver therapy, were linked to poorer outcomes. The study questions current prognostic models and selection criteria, emphasizing the need for more accurate tools to guide decision-making in patients with colorectal liver metastases.
结直肠癌肝转移（CRLM）的肝移植（LT）越来越受到关注，尤其是在TransMet试验发表之后。然而，多变量生存分析尚缺乏。在此，我们在一个多中心队列中进行了这样的分析。
我们对美国和欧洲7个中心的82例接受LT的CRLM患者（2006年至2020年）进行了一项回顾性多中心研究，使用多变量Cox模型、竞争风险模型以及广泛的敏感性分析。
1年、3年和5年的总生存率分别为93.7%、73.4%和54.9%。研究结果表明高风险与女性性别（估计风险比（HR）4.1，95%置信区间：1.8 - 9.2）以及以下变量相关：癌胚抗原>80μg/L、右半结肠癌（CRC）、最大直径>5.5cm、KRAS突变以及既往未接受过肝脏治疗。其他不确定性较高的可能相关因素为pN2阳性CRC和结节数量（>10个）。移植前化疗后疾病进展以及从原发性CRC手术到LT的时间≤24个月等变量的相关性较弱且不太一致。
这项首次针对CRLM的LT多变量生存分析表明，女性性别与较差的预后相关，而目前临床实践中使用的模型的预后强度未得到证实。我们的研究结果对当前的选择标准提出了挑战，强调需要改进具有更好区分度和校准度的预后模型。
这项多中心回顾性研究分析了美国和欧洲7个中心82例接受结直肠癌肝转移肝移植患者的生存结局。包括女性性别、高癌胚抗原水平、右半结肠癌、较大肿瘤、KRAS突变、pN2阳性CRC、结节数量以及既往未接受过肝脏治疗等多个因素与较差的预后相关。该研究对当前的预后模型和选择标准提出了质疑，强调需要更准确的工具来指导结直肠癌肝转移患者的决策制定。
