Lu Ping, Li Yaqi, Chen Zhiyu, Zou Jianling, Peng Junjie
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Gastrointest Oncol. 2025 Aug 30;16(4):1586-1596. doi: 10.21037/jgo-2025-221. Epub 2025 Aug 27.
Palliative chemotherapy is the standard first treatment for patients with ≥10 liver metastases, irrespective of resectability. This study aimed to assess the clinical benefits of hepatic resection and identify optimal treatments for colorectal cancer patients with ≥10 liver-limited metastases (LLMs).
A retrospective study of 373 patients with unresectable colorectal cancer and ≥10 liver metastases. Patients were grouped into hepatic surgery ± radiofrequency ablation (RFA) + systemic therapy, RFA + systemic therapy, and systemic therapy alone. Kaplan-Meier and Cox proportional hazards methods were used to analyze overall survival (OS) and progression-free survival (PFS). A nomogram was developed and validated.
Three-year survival rates were 39.2%, 18.6%, and 8.2% for surgery ± RFA + systemic, RFA + systemic, and systemic only groups, respectively. Significant survival differences were noted in both wildtype and mutated cohorts. For wildtype LLMs, OS and PFS were 39.3 and 13.8 months for surgery ± RFA + systemic, compared to 23.9 and 9.9 months for RFA + systemic. The nomogram (C-index =0.709) identified independent prognostic factors for OS.
Hepatectomy, with or without RFA, is associated with significantly improved survival in selected patients with ≥10 liver metastases. Further prospective studies are needed to confirm these findings.
姑息性化疗是肝转移灶≥10个的患者的标准一线治疗方法，无论其是否可切除。本研究旨在评估肝切除的临床获益，并确定肝转移灶≥10个的局限性肝转移（LLM）结直肠癌患者的最佳治疗方法。
对373例不可切除的结直肠癌且肝转移灶≥10个的患者进行回顾性研究。患者被分为肝手术±射频消融（RFA）+全身治疗组、RFA+全身治疗组和单纯全身治疗组。采用Kaplan-Meier法和Cox比例风险法分析总生存期（OS）和无进展生存期（PFS）。构建并验证了列线图。
手术±RFA+全身治疗组、RFA+全身治疗组和单纯全身治疗组的三年生存率分别为39.2%、18.6%和8.2%。在野生型和突变型队列中均观察到显著的生存差异。对于野生型LLM，手术±RFA+全身治疗组的OS和PFS分别为39.3个月和13.8个月，而RFA+全身治疗组分别为23.9个月和9.9个月。列线图（C指数=0.709）确定了OS的独立预后因素。
对于部分肝转移灶≥10个的患者，肝切除术（无论是否联合RFA）与显著改善的生存率相关。需要进一步的前瞻性研究来证实这些发现。
