First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases
First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases
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DOI：
10.1097/sla.0000000000004330
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发表时间：
2020-11-01
影响因子：
9
通讯作者：
Clavien, Pierre-Alain
中科院分区：
文献类型：
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作者：
Petrowsky, Henrik;Linecker, Michael;Clavien, Pierre-Alain
目的：为了分析长期肿瘤学结果沿着预后危险因素在一个大的队列的结直肠癌肝转移（CRLM）患者接受ALPPS.Background：ALPPS是一个两阶段肝切除术的变种，增加切除率和R 0切除率主要不可切除的CRLM患者在最近的随机对照试验证明。长期的肿瘤学结果，然而，lacking.Methods：国际ALPPS登记处内外的情况下，收集和完成直接接触ALPPS中心，以确保一个全面的队列。总体而言，癌症特异性（CSS）和无复发（RFS）生存率进行了分析沿着与独立的危险因素使用Cox回归analysis.Results：队列包括510例患者从22 ALPPS中心超过10年的时间。90天死亡率为4.9%，中位总生存期、CSS和RFS分别为39、42和15个月。中位随访时间为38个月（95%置信区间为32-43个月）。多变量分析将肿瘤特征（原发性T4，右结肠）、生物学特征（K/N-RAS状态）和化疗反应（实体瘤反应评价标准）确定为CSS的独立预测因素。传统的因素如转移灶的大小、单叶或双叶受累、肝脏优先入路等均不能预测。当ALPPS后肝复发适合手术/消融治疗时，中位CSS明显优于单纯化疗，上级（56个月vs 30个月，P < 0.001）。这个大的队列提供了第一个证据，证明ALPPS治疗的原发性不可切除CRLM患者不仅围手术期死亡率低，但实现了吸引人的长期肿瘤学结果，特别是那些具有良好肿瘤生物学和对化疗的良好反应的肿瘤。
Objectives: To analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS.Background: ALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking.Methods: Cases in- and outside the International ALPPSRegistry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis.Results: The cohort included 510 patients from 22 ALPPS centers over a 10year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32-43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liverfirst approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001).Conclusions: This large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy.