Outcome of posthepatectomy-missing colorectal liver metastases after complete response to chemotherapy: Impact of adjuvant intra-arterial hepatic oxaliplatin
Outcome of posthepatectomy-missing colorectal liver metastases after complete response to chemotherapy: Impact of adjuvant intra-arterial hepatic oxaliplatin
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DOI：
10.1245/s10434-007-9482-9
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发表时间：
2007-11-01
影响因子：
3.7
通讯作者：
Ducreux, Michel
中科院分区：
文献类型：
--
作者：
Elias, Dominique;Goere, Diane;Ducreux, Michel
背景：多发性结直肠肝转移（LM）患者对化疗的显着反应越来越频繁地发生，导致切除。在少数患者中，一些 LM 在影像学研究中消失，在肝切除过程中未被发现，并留在原处，这定义了“缺失的 LM”。我们研究的目的是评估这种“缺失LM”的长期结果。 患者：1999年1月至2004年6月期间，在228名接受结直肠LM治疗的患者中，有16名患者观察到LM缺失。所有患者均在影像学检查后 4 周内接受手术。 12 名患者 (75%) 接受了奥沙利铂肝动脉输注 (HAI)：其中 7 名患者在肝切除术之前，5 名患者在肝切除术之后。 结果：总体而言，诊断出 69 个缺失的 LM，并将其保留在原位。在持续切除的 LM 中，术前发生 HAI 的组（7 例中的 6 例）比未发生 HAI 的组（9 例中的 2 例，P < .02）更容易观察到完全病理反应。平均随访 51 个月 (24-90)，10 名患者 (62%) 缺失的 LM 没有再次出现。辅助 HAI 与缺失 LM 的彻底根除显着相关 (P < .01)，因为它不是完全的病理反应。这些精心挑选的 16 名患者的总体 3 年生存率为 94%。结论：化疗下的结直肠 LM 在高质量影像学研究中消失，在肝切除过程中未被发现，并留在原处，62% 的病例得到明确治愈。这一优异的结果似乎归功于辅助肝动脉灌注化疗，应该会激发新的研究。
Background: Dramatic responses to chemotherapy are occurring more and more frequently in patients with multiple colorectal liver metastases (LMs), leading to resection. In a few patients, some LMs vanish on imaging studies, remain undetected during hepatectomy, and are left in place, which defines the "missing LMs." The aim of our study was to assess the long-term outcome of such "missing LMs."Patients: Between January 1999 and June 2004, among 228 patients treated for colorectal LMs, missing LMs were observed in 16 patients. All the patients were operated within 4 weeks of imaging. Hepatic arterial infusion (HAI) with oxaliplatin was administrated in 12 patients (75%): seven before hepatectomy and five after.Results: Overall, 69 missing LMs were diagnosed and left in place. Among the persistent LMs resected, a complete pathological response was significantly more often observed in the group with preoperative HAI (6 of 7), than in the group without (2 of 9, P < .02). With a mean follow-up of 51 months (24-90), missing LMs did not reappear in 10 patients (62%). Adjuvant HAI was significantly correlated with the definitive eradication of missing LMs (P < .01), as it was not a complete pathological response. The overall 3-year survival rate of these highly selected 16 patients was 94%.Conclusion: Colorectal LMs under chemotherapy that vanish on high-quality imaging studies, remain undetected during hepatectomy, and are left in place, are definitively cured in 62% of cases. This excellent result seems to be due to the administration of adjuvant hepatic arterial infusion of chemotherapy and should stimulate new investigations.