Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?
Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?
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DOI：
10.1016/j.surg.2018.01.004
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发表时间：
2018-06
期刊：
影响因子：
3.8
通讯作者：
D'Angelica MI
中科院分区：
文献类型：
--
作者：
Creasy JM;Sadot E;Koerkamp BG;Chou JF;Gonen M;Kemeny NE;Balachandran VP;Kingham TP;DeMatteo RP;Allen PJ;Blumgart LH;Jarnagin WR;D'Angelica MI
肝切除结直肠癌肝转移(CRLM)与长期生存有关。这项研究分析了CRLM切除后10年的实际幸存者，报告了观察到的治愈率，并确定了排除治愈的因素。在一个单一机构的、预期维护的数据库中查询1992-2004年间CRLM的所有初步切除。观察到的治愈定义为实际生存10年，无复发或切除复发，至少3年无病随访。临床风险评分(CRS)分为低(0~2)和高(3~5)。采用半参数比例风险混合治愈模型估计治愈概率。纳入了1211名患者，对幸存者进行了11年的中位随访。中位DSS为4.9年(95%可信区间：4.4~5.3)。295例患者(24.4%)是实际的10年生存者。观察治愈率为20.6%(n=250)。在250例治愈患者中，192例(76.8%)无复发，58例(23.2%)切除复发，术后至少3年无病随访。肝外疾病(EHD)88例，CEA>；200例(n=119)，切缘阳性(n=109)，GT；10例(n=31)。在治愈模型分析中，同时患有EHD和高CRS的患者(n=31)的估计治愈概率为3.5%。CRLM切除后的实际10年生存率为24%，观察到的治愈率为20%。同时患有高CRS和EHD的患者估计治愈的可能性不到5%。当这些因素被确定时，可能会强烈考虑术前策略，如新辅助化疗，以帮助选择患者进行手术治疗。CRLM切除后的实际10年生存率为24%，观察到的治愈率为20%。这份报告的意义在于，没有单一因素排除治愈，尽管同时患有高CRS和EHD的患者估计治愈的可能性为3.5%。
Hepatic resection of colorectal liver metastases (CRLM) is associated with long-term survival. This study analyzes actual 10-year survivors following resection of CRLM, reports the observed rate of cure, and identifies factors that preclude cure. A single-institution, prospectively-maintained database was queried for all initial resections for CRLM 1992–2004. Observed cure was defined as actual 10-year survival with either no recurrence or resected recurrence with at least 3 years of disease-free follow-up. Clinical risk score (CRS) was dichotomized into low (0–2) and high (3–5). Semiparametric proportional hazards mixture cure model was utilized to estimate probability of cure. 1211 patients were included with a median follow-up for survivors of 11 years. Median DSS was 4.9 years (95% CI: 4.4–5.3). 295 patients (24.4%) were actual 10-year survivors. The observed cure rate was 20.6% (n=250). Among 250 cured patients, 192 (76.8%) had no recurrence and 58 (23.2%) had a resected recurrence with at least 3 years of disease-free follow-up. Extrahepatic disease (EHD, n=88), CEA >200 (n=119), positive margin (n=109), and >10 tumors (n=31) had observed cure rates less than 10%. In cure model analysis, patients with both EHD and high CRS (n=31) had an estimated probability of cure of 3.5%. Actual 10-year survival after resection of CRLM is 24% with an observed 20% cure rate. Patients with both high CRS and EHD have an estimated probability of cure less than 5%. When such factors are identified, strong consideration may be given to preoperative strategies, such as neoadjuvant chemotherapy, to help select patients for surgical therapy. Actual 10-year survival after resection of CRLM is 24% with an observed 20% cure. The significance of this report is that no single factor precludes cure, although patients with both a high CRS and EHD had an estimated probability of cure of 3.5%.
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影响因子：
45.3
作者：
Sanoff, Hanna K.;Sargent, Daniel J.;Goldberg, Richard M.
通讯作者：
Goldberg, Richard M.
影响因子：
9
作者：
Fong, Y;Fortner, J;Blumgart, LH
通讯作者：
Blumgart, LH
DOI：
10.1016/j.jamcollsurg.2005.03.019
发表时间：
2005-07-01
影响因子：
5.2
作者：
Allen, PJ;Nissan, A;Paty, PB
通讯作者：
Paty, PB
影响因子：
158.5
作者：
Kemeny, N;Huang, Y;Fong, YM
通讯作者：
Fong, YM
影响因子：
5.2
作者：
Iwatsuki, S;Dvorchik, I;Starzl, TE
通讯作者：
Starzl, TE