Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry.
Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry.
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DOI：
10.1245/s10434-021-10220-w
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发表时间：
2021-12
影响因子：
3.7
通讯作者：
Adam R
中科院分区：
文献类型：
--
作者：
Giuliante F;Viganò L;De Rose AM;Mirza DF;Lapointe R;Kaiser G;Barroso E;Ferrero A;Isoniemi H;Lopez-Ben S;Popescu I;Ouellet JF;Hubert C;Regimbeau JM;Lin JK;Skipenko OG;Ardito F;Adam R
肝先入路治疗同步性结直肠肝转移（CRLM）已获得广泛共识，但其作用仍有待阐明。我们的目的是阐明肝脏优先方法的结果，并确定从这种方法中获益最多的患者。考虑了2000年至2017年期间LiverMetSurvey登记研究中纳入的同步CRLM患者。分析了三种策略，即肝脏优先方法，结直肠切除术后肝脏切除术（原发性优先）和同时切除术，并分析了三组患者，即孤立转移，多发性单叶CRLM和多发性双叶CRLM。在每组中，通过倾向评分分析匹配来自三个策略组的患者。总体而言，分析了7360例患者：4415例初次切除，552例肝脏切除，2393例同时切除。与其他组相比，肝脏优先组的直肠肿瘤更多（58.0%比31.2%），肝脏肿瘤负荷更高（超过3个CRLM：34.8%比24.0%;尺寸> 50 mm：35.6%比22.8%; p < 0.001）。在单发和多发的单叶CRLM患者中，无论治疗策略如何，生存率相似，而在多发的双叶转移患者中，肝脏优先治疗是一个独立的积极预后因素，这两种治疗方法都不匹配（3年生存率65.9% vs.初次手术60.4%：风险比[HR] 1.321，p = 0.031; vs.同期切除54.4%：HR 1.624，p < 0.001）和倾向评分匹配后（vs.初次-首次：HR 1.667，p = 0.017; vs.同时切除：HR 2.278，p = 0.003）。对于同时性CRLM患者，应根据肝脏肿瘤负荷决定手术策略。在存在多个双叶CRLM的情况下，肝脏优先方法与替代方法相比生存期更长，应作为标准进行评估。在线版本包含补充材料，可通过10.1245/s10434-021-10220-w获得。
The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to elucidate the outcome of the liver-first approach and to identify patients who benefit at most from this approach. Patients with synchronous CRLM included in the LiverMetSurvey registry between 2000 and 2017 were considered. Three strategies were analyzed, i.e. liver-first approach, colorectal resection followed by liver resection (primary-first), and simultaneous resection, and three groups of patients were analyzed, i.e. solitary metastasis, multiple unilobar CRLM, and multiple bilobar CRLM. In each group, patients from the three strategy groups were matched by propensity score analysis. Overall, 7360 patients were analyzed: 4415 primary-first, 552 liver-first, and 2393 simultaneous resections. Compared with the other groups, the liver-first group had more rectal tumors (58.0% vs. 31.2%) and higher hepatic tumor burden (more than three CRLMs: 34.8% vs. 24.0%; size > 50 mm: 35.6% vs. 22.8%; p < 0.001). In patients with solitary and multiple unilobar CRLM, survival was similar regardless of treatment strategy, whereas in patients with multiple bilobar metastases, the liver-first approach was an independent positive prognostic factor, both in unmatched patients (3-year survival 65.9% vs. primary-first 60.4%: hazard ratio [HR] 1.321, p = 0.031; vs. simultaneous resections 54.4%: HR 1.624, p < 0.001) and after propensity score matching (vs. primary-first: HR 1.667, p = 0.017; vs. simultaneous resections: HR 2.278, p = 0.003). In patients with synchronous CRLM, the surgical strategy should be decided according to the hepatic tumor burden. In the presence of multiple bilobar CRLM, the liver-first approach is associated with longer survival than the alternative approaches and should be evaluated as standard. The online version contains supplementary material available at 10.1245/s10434-021-10220-w.
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影响因子：
2.9
作者：
Idrees, Jay J.;Bagante, Fabio;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
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作者：
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