High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome
High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome
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DOI：
10.1200/jco.2010.32.6132
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发表时间：
2011-03-01
影响因子：
45.3
通讯作者：
Vauthey, Jean-Nicolas
中科院分区：
文献类型：
--
作者：
Brouquet, Antoine;Abdalla, Eddie K.;Vauthey, Jean-Nicolas
目的晚期结直肠癌肝转移（CLM）二期切除（TSR）后生存期延长可能是选择化疗最佳反应者的结果。在这个精心挑选的group.Patients和MethodsData 890例切除和879例仅接受化疗CLM患者的完整切除的影响是有争议的。我们使用意向治疗分析来评估接受TSR的患者的生存率。此外，我们评估了一个队列的非手术治疗的患者选择反映TSR人口：结直肠癌转移与肝脏唯一的疾病，化疗的客观反应，并存活1年后化疗initiation.Results65例患者进行了第一阶段的TSR; 62例患者符合医疗组的入选标准。TSR患者的平均CLM为6.7 ± 3.4，平均尺寸为4.5 ± 3.1 cm。非手术患者的平均CLM为5.9 ± 2.9，平均尺寸为5.4 ± 3.4 cm（不显著）。47名TSR患者（72%）完成了第二阶段。阶段间进展是第二阶段未完成的主要原因（61%）。中位随访50个月后，TSR组的5年生存率为51%，药物组为15%（P = 0.005）。在接受TSR的患者中，TSR和主要术后并发症的不完整性与较差的survival.ConclusionTSR与晚期CLM患者的良好结局相关，因为化疗和转移性疾病的完全切除的选择。J Clin Oncol 29：1083-1090. (c)2011年美国临床肿瘤学会
PurposeProlonged survival after two-stage resection (TSR) of advanced colorectal liver metastases (CLM) may be the result of selection of best responders to chemotherapy. The impact of complete resection in this well-selected group is controversial.Patients and MethodsData on 890 patients undergoing resection and 879 patients who received only chemotherapy for CLM were collected prospectively. We used intent-to-treat analysis to evaluate the survival of patients who underwent TSR. Additionally, we evaluated a cohort of nonsurgically treated patients selected to mirror the TSR population: colorectal metastases with liver-only disease, objective response to chemotherapy, and alive 1 year after chemotherapy initiation.ResultsSixty-five patients underwent the first stage of TSR; 62 patients fulfilled the inclusion criteria for the medical group. TSR patients had a mean of 6.7 +/- 3.4 CLM with mean size of 4.5 +/- 3.1 cm. Nonsurgical patients had a mean of 5.9 +/- 2.9 CLM with mean size of 5.4 +/- 3.4 cm (not significant). Forty-seven TSR patients (72%) completed the second stage. Progression between stages was the main cause of noncompletion of the second stage (61%). After 50 months median follow-up, the 5-year survival rate was 51% in the TSR group and 15% in the medical group (P = .005). In patients who underwent TSR, noncompletion of TSR and major postoperative complications were independently associated with worse survival.ConclusionTSR is associated with excellent outcome in patients with advanced CLM as a result of both selection by chemotherapy and complete resection of metastatic disease. J Clin Oncol 29:1083-1090. (c) 2011 by American Society of Clinical Oncology