Preoperative Bevacizumab Does Not Significantly Increase Postoperative Complication Rates in Patients Undergoing Hepatic Surgery for Colorectal Cancer Liver Metastases
Preoperative Bevacizumab Does Not Significantly Increase Postoperative Complication Rates in Patients Undergoing Hepatic Surgery for Colorectal Cancer Liver Metastases
复制标题
DOI：
10.1200/jco.2008.17.7857
复制
发表时间：
2008-11-10
影响因子：
45.3
通讯作者：
Feig, Barry W.
中科院分区：
文献类型：
--
作者：
Kesmodel, Susan B.;Ellis, Lee M.;Feig, Barry W.
目的：尽管贝伐单抗（BV）与化疗（CTX）联合使用可提高转移性结直肠癌（CRC）患者的生存率，但在接受BV的同时进行手术的患者中观察到伤口并发症的增加。因此，我们评估了新辅助BV是否与结直肠癌肝转移手术患者术后并发症的增加有关。患者和方法从接受结直肠癌肝转移手术的患者数据库中确定了两组接受新辅助CTX + BV （n = 81）或单独CTX （n = 44）的患者。采用单因素和多因素logistic回归模型评估患者和肿瘤特征、新辅助治疗和手术因素与术后并发症的关系。结果CTX + BV组40例（49%）出现术后并发症，CTX组19例（43%）出现术后并发症。从BV停药到手术的中位时间为58天（范围31 ~ 117天）。BV使用与BV停药时间和术后并发症之间没有明显的关联。在多因素分析中，较低的血清白蛋白和伴随的外科手术与发生任何并发症的风险增加相关（P = 0.035和P = 0.035）。低血清白蛋白与肝胆并发症相关（P = 0.016）。结论BV的使用和给药时间与并发症发生率的增加无关。这些数据表明，BV联合新辅助CTX治疗结直肠癌肝转移患者不会增加手术并发症。为了确定接受新辅助BV的患者的最佳手术时机，需要进行确证性前瞻性研究。
PurposeAlthough bevacizumab (BV) increases survival rates when used with chemotherapy (CTX) in patients who have metastatic colorectal cancer (CRC), an increase in wound complications has been observed in patients who undergo surgery while receiving BV. We therefore evaluated whether neoadjuvant BV is associated with an increase in postoperative complications in patients undergoing surgery for CRC liver metastases.Patients and MethodsTwo subgroups of patients who received neoadjuvant CTX + BV (n = 81) or CTX alone (n = 44) were identified from a database of patients who underwent surgery for CRC liver metastases. Univariate and multivariate logistic regression models were used to evaluate the association of patient and tumor characteristics, neoadjuvant therapy, and operative factors with postoperative complications.ResultsPostoperative complications developed in 40 patients (49%) who received CTX + BV and 19 patients (43%) who received CTX. The median time from BV discontinuation to surgery was 58 days (range, 31 to 117 days). No significant associations were identified between BV use and timing of BV discontinuation and postoperative complications. On multivariate analysis, lower serum albumin and concomitant surgical procedures were associated with an increased risk of developing any complication (P = .035 and .023, respectively), and lower serum albumin was associated with hepatobiliary complications (P = .016).ConclusionNeither the use of BV nor timing of BV administration was associated with an increase in complication rates. These data suggest that the combination of BV with neoadjuvant CTX in patients who have CRC liver metastases does not increase surgical complications. To determine the optimal timing of surgery in patients receiving neoadjuvant BV, confirmatory prospective studies are required.