Second hepatectomy for recurrent colorectal liver metastasis: Analysis of preoperative prognostic factors
Second hepatectomy for recurrent colorectal liver metastasis: Analysis of preoperative prognostic factors
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DOI：
10.1245/s10434-006-9067-z
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发表时间：
2006-12-01
影响因子：
3.7
通讯作者：
Moriya, Yoshihiro
中科院分区：
文献类型：
--
作者：
Ishiguro, Seiji;Akasu, Takayuki;Moriya, Yoshihiro
背景：二次肝切除术是治疗结直肠癌肝复发的一种潜在的治疗方法。然而，在这种情况下，二次肝切除的患者选择标准仍然没有达成共识，影响二次肝切除预后的因素仍然不确定。方法：对1985-2004年间在同一机构接受二次肝切除的111例结直肠癌肝转移患者的临床病理资料进行单因素和多因素分析。结果：发病率和死亡率分别为14%和0%，总的5年生存率为41%。多因素分析显示，首次肝转移同期切除(风险比为1.8)、第二次肝切除时肿瘤超过3个(1.9)、第一次肝转移累及肝静脉和/或门静脉(1.7)与预后不良独立相关。我们利用这三个危险因素设计了一个术前预测生存的模型。无危险因素组和有1、2、3个危险因素组的5年生存率分别为62%、38%、19%和0%。结论：无危险因素的患者二次肝切除是有益的。在二次肝切除术前，对于有上述任何危险因素的患者，尤其是有两个或三个危险因素的患者，应考虑在辅助或新辅助环境下进行化疗，以延长生存期。这些结果需要在另一个数据集或未来的前瞻性试验中根据我们概述的评分方案进行确认和验证。
Background: Second hepatectomy is a potentially curative treatment for patients with hepatic recurrence of colorectal cancer. However, there is still no consensus about the patient selection criteria for second hepatectomy under these circumstances, and the factors affecting prognosis after second hepatectomy remain uncertain.Methods: Clinicopathologic data for 111 consecutive patients with colorectal liver metastasis who underwent second hepatectomy at a single institution between 1985 and 2004, and for whom complete clinicopathologic reports were available, were subjected to univariate and multivariate analyses.Results: The morbidity and mortality rates were 14% and 0%, respectively, and the overall 5-year survival rate was 41%. Multivariate analysis revealed that synchronous resection for the first liver metastasis (hazard ratio, 1.8), more than three tumors at the second hepatectomy (1.9), and histopathological involvement of the hepatic vein and/or portal vein by the first liver metastasis (1.7) were independently associated with poor survival. We used these three risk factors to devise a preoperative model for predicting survival. The 5-year survival rates of patients without any risk factors, and with one, two, or three risk factors, were 62%, 38%, 19%, and 0%, respectively.Conclusions: Second hepatectomy is beneficial for patients without any risk factors. Before second hepatectomy, chemotherapy should be considered for patients with any of these risk factors, especially with two or three factors, in the adjuvant or neoadjuvant setting to prolong survival. These results need to be confirmed and validated in another data set or future prospective trial according to the scoring scheme we outline.