Identification of patients likely to benefit from metastasectomy in stage IV colorectal cancer
Identification of patients likely to benefit from metastasectomy in stage IV colorectal cancer
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DOI：
10.1007/s00384-012-1454-2
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发表时间：
2012-10-01
影响因子：
2.8
通讯作者：
Ohdan, Hideki
中科院分区：
文献类型：
--
作者：
Shimomura, Manabu;Okajima, Masazumi;Ohdan, Hideki
本研究的目的是确定可能通过转移切除术获得生存获益的 IV 期结直肠癌 (CRC) 患者的选择标准。对 119 例接受原发性 CRC 切除术的 IV 期 CRC 患者的临床病理数据进行回顾性分析。根据疾病可切除性状态分析预后因素，并确定可能显示转移灶切除术生存获益的患者。63例患者接受了转移灶切除术。在这些患者中，有 55 名患者报告进行了 R0 切除，他们构成了可治愈组。其他 64 名患者属于不可治愈组。对于无法治愈的组，术后化疗被认为是唯一重要的预后因素。在可治愈组中，T分期、组织学类型、血清癌胚抗原（CEA）水平升高和肝外疾病的存在被确定为独立的预后因素。可治愈组内的患者被进一步分为低风险组（零至两个预后因素）和高风险组（三个或更多预后因素）。可治愈组中高风险患者的总生存期 (OS) 与不可治愈组中的患者一样差。 IV 期 CRC 患者由具有不同预后因素的异质人群组成，并按疾病可切除状态进行分层。在接受根治性转移切除术的高危患者中没有观察到转移切除术的预后益处。这些结果表明，通过考虑接受根治性转移切除术的患者的预后因素，可以确定显示出转移灶切除术的生存获益的患者。
The aim of the present study was to determine selection criteria for patients with stage IV colorectal cancer (CRC) who were likely to show survival benefits of metastasectomy.Clinicopathological data of 119 patients with stage IV CRC who underwent primary CRC resection were retrospectively reviewed. The prognostic factors were analyzed according to the disease resectability status, and patients likely to show survival benefits of metastasectomy were identified.Metastasectomy was performed in 63 patients. Among these patients, R0 resection was reported in 55 patients, who comprised the curable group. The other 64 patients comprised the noncurable group. For the noncurable group, postoperative chemotherapy was identified as the only significant prognostic factor. In the curable group, T stage, histological type, elevated serum carcinoembryonic antigen (CEA) level and the presence of extra hepatic disease were identified as independent prognostic factors. Patients within the curable group were further classified into a low-risk group (zero to two prognostic factors) and a high-risk group (three or more prognostic factors). The overall survival (OS) of the high risk patients in the curable group was as poor as that of the patients in the noncurable group.Stage IV CRC patients consisted of heterogeneous populations who had different prognostic factors, stratified by the disease resectability status. No prognostic benefit of metastasectomy was observed in high-risk patients undergoing curative metastasectomy. These results suggested that patients showing survival benefits of metastasectomy can be identified by considering the prognostic factors in patients undergoing curative metastasectomy.