Clinical outcomes of neoadjuvant chemotherapy for resectable colorectal liver metastasis with intermediate risk of postoperative recurrence: A multi-institutional retrospective study.
Clinical outcomes of neoadjuvant chemotherapy for resectable colorectal liver metastasis with intermediate risk of postoperative recurrence: A multi-institutional retrospective study.
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DOI：
10.1002/ags3.12631
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发表时间：
2023-05
影响因子：
2.7
通讯作者：
Eguchi, Hidetoshi
中科院分区：
文献类型：
--
作者：
Noda, Takehiro;Takahashi, Hidekazu;Tei, Mitsuyoshi;Nishida, Naohiro;Hata, Taishi;Takeda, Yutaka;Ohue, Masayuki;Wada, Hiroshi;Mizushima, Tsunekazu;Asaoka, Tadafumi;Uemura, Mamoru;Kobayashi, Shogo;Murata, Kohei;Satoh, Taroh;Doki, Yuichiro;Eguchi, Hidetoshi
肝切除术后结直肠肝转移（CRLM）的风险评分系统允许术前预测肿瘤。我们根据患者的风险状态调查了可切除CRLM的新辅助化疗的临床结局，旨在确定可从新辅助化疗中获益的患者亚组。在这项多机构回顾性分析中，术前风险评分是根据6个先前报告的因素计算的：同步转移、原发淋巴结阳性、肿瘤数量、最大肿瘤直径、肝外转移和术前碳水化合物抗原19-9水平。根据风险评分将患者分为三组：低风险（评分= 0）、中等风险（评分1-10）和高风险（评分≥11）。使用Kaplan-Meier方法计算总生存期和无复发生存期曲线。在中等风险组的倾向评分匹配后，我们比较了临床病理特征和结局。共有318起案件，来自20个机构。277例可计算术前风险评分。低、中和高风险组分别有34、192和51例患者。接受新辅助化疗的中危组患者的无复发生存率显著高于未接受新辅助化疗的患者（P = 0.0453）。在中等风险组中进行倾向评分匹配后，接受新辅助化疗的患者的无复发生存率更高（P = 0.0261）。但配型后总生存率没有提高。对于术前风险评分为1-10的中危患者，可切除CRLM的新辅助化疗可能延长无复发生存期，但新辅助化疗并未改善总生存期。可切除CRLM的新辅助化疗可能延长术前风险评分在1 - 10范围内的中等风险患者的无复发生存期。
Risk‐scoring systems for colorectal liver metastasis (CRLM) after hepatectomy allow prognoses to be predicted preoperatively. We investigated the clinical outcomes of neoadjuvant chemotherapy for resectable CRLM according to patient risk status, aiming to determine the subgroup of patients who could benefit from neoadjuvant chemotherapy. In this multi‐institutional retrospective analysis, the preoperative risk score was calculated from six previously reported factors: synchronous metastases, primary lymph node positivity, tumor number, largest tumor diameter, extrahepatic metastasis, and the preoperative carbohydrate antigen 19–9 level. Patients were divided into three groups according to their risk scores: low risk (score = 0), intermediate risk (score 1–10), and high risk (score ≥11). Overall and recurrence‐free survival curves were calculated using the Kaplan–Meier method. After propensity‐score matching in the intermediate‐risk group, we compared clinicopathological features and outcomes. There were 318 cases, from 20 institutions. The preoperative risk score could be calculated in 277 cases. There were 34, 192, and 51 patients in the low‐, intermediate‐, and high‐risk groups, respectively. Intermediate‐risk group patients who received neoadjuvant chemotherapy had significantly better recurrence‐free survival than that of patients without neoadjuvant chemotherapy (P = .0453). After propensity‐score matching in the intermediate‐risk group, the recurrence‐free survival rate was better in patients who received neoadjuvant chemotherapy (P = .0261). But the overall survival rate was not improved after the matching. Neoadjuvant chemotherapy for resectable CRLM might prolong the recurrence‐free survival period for intermediate‐risk patients with preoperative risk scores in the range of 1–10, but the overall survival was not improved by neoadjuvant chemotherapy. Neoadjuvant chemotherapy for resectable CRLM might prolong the recurrence‐free survival period for intermediate‐risk patients with preoperative risk scores in the range of 1‐10.
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