Adjuvant therapy after resection of colorectal liver metastases: the predictive value of the MSKCC clinical risk score in the era of modern chemotherapy.
Adjuvant therapy after resection of colorectal liver metastases: the predictive value of the MSKCC clinical risk score in the era of modern chemotherapy.
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DOI：
10.1186/1471-2407-14-174
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发表时间：
2014-03-11
期刊：
影响因子：
3.8
通讯作者：
Koch M
中科院分区：
文献类型：
--
作者：
Rahbari NN;Reissfelder C;Schulze-Bergkamen H;Jäger D;Büchler MW;Weitz J;Koch M
尽管引入了有效的化疗方案，但结直肠癌（CRC）肝转移患者是否应该接受辅助治疗仍不确定。临床或分子预测因子可能有助于选择疾病复发和死亡高风险的患者，通过辅助化疗获得生存优势。总共分析了 297 名具有潜在治愈性切除 CRC 肝转移的患者。这些患者没有接受新辅助治疗，没有肝外疾病，且切除边缘呈阴性。主要终点是总生存期。使用纪念斯隆-凯特琳癌症中心临床风险评分 (MSKCC-CRS) 评估患者的风险状态。使用 Cox 比例风险模型进行多变量分析。共有 137 名（43%）患者患有 MSKCC-CRS > 2。其中 116 名（37%）患者接受了辅助化疗。接受辅助化疗的患者年龄较轻（p = 0.03），在多发转移（p = 0.72）或双叶转移（p = 0.08）方面无显着差异。多变量分析表明，辅助化疗与整个队列的生存率改善相关（风险比 0.69；95% 置信区间 0.69–0.98）。它显着提高了 MSKCC-CRS > 2 的高危患者的生存率（HR 0.40；95% CI 0.23–0.69），而对于 MSKCC-CRS ≤ 2 的患者没有任何益处（HR 0.90；95% CI 0.57–1.43）。 MSKCC-CRS 提供了一种工具来选择 CRC 肝转移切除后进行辅助治疗的患者。需要在独立患者队列中进行验证。
Despite introduction of effective chemotherapy protocols, it has remained uncertain, if patients with colorectal cancer (CRC) liver metastases should receive adjuvant therapy. Clinical or molecular predictors may help to select patients at high risk for disease recurrence and death who obtain a survival advantage by adjuvant chemotherapy. A total of 297 patients with potentially curative resection of CRC liver metastases were analyzed. These patients had no neoadjuvant therapy, no extrahepatic disease and negative resection margins. The primary endpoint was overall survival. Patients’ risk status was evaluated using the Memorial Sloan-Kettering Cancer Center clinical risk score (MSKCC-CRS). Multivariable analyses were performed using Cox proportional hazard models. A total of 137 (43%) patients had a MSKCC-CRS > 2. Adjuvant chemotherapy was administered to 116 (37%) patients. Patients who received adjuvant chemotherapy were of younger age (p = 0.03) with no significant difference in the presence of multiple metastases (p = 0.72) or bilobar metastases (p = 0.08). On multivariate analysis adjuvant chemotherapy was associated with improved survival in the entire cohort (Hazard ratio 0.69; 95% confidence interval 0.69–0.98). It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23–0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57–1.43). The MSKCC-CRS offers a tool to select patients for adjuvant therapy after resection of CRC liver metastases. Validation in independent patient cohorts is required.
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影响因子：
8.4
作者：
André, T;Louvet, C;de Gramont, A
通讯作者：
de Gramont, A
影响因子：
9
作者：
Fong, Y;Fortner, J;Blumgart, LH
通讯作者：
Blumgart, LH
影响因子：
3.8
作者：
Maithel, Shishir K.;Goenen, Mithat;D'Angelica, Michael I.
通讯作者：
D'Angelica, Michael I.
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影响因子：
168.9
作者：
Nordlinger, Bernard;Sorbye, Halfdan;Glimelius, Bengt;Poston, Graeme J.;Schlag, Peter M.;Rougier, Philippe;Bechstein, Wolf O.;Primrose, John N.;Euan, T. Walpole;Finch-Jones, Meg;Jaeck, Daniel;Mirza, Darius;Parks, Rowan W.;Collette, Laurence;Praet, Michel;Bethe, Ullrich;Van Cutsem, Eric;Scheithauer, Werner;Gruenberger, Thomas
通讯作者：
Gruenberger, Thomas
影响因子：
45.3
作者：
Goldberg, RM;Sargent, DJ;Alberts, SR
通讯作者：
Alberts, SR