Five-Year Survival Following Hepatic Resection After Neoadjuvant Therapy for Nonresectable Colorectal [Liver] Metastases
Five-Year Survival Following Hepatic Resection After Neoadjuvant Therapy for Nonresectable Colorectal [Liver] Metastases
复制标题
不可切除结直肠[肝]转移瘤新辅助治疗后肝切除术后的五年生存率
DOI：
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发表时间：
2001
影响因子：
3.7
通讯作者：
F. Bismuth
中科院分区：
文献类型：
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作者：
R. Adam;E. Avisar;A. Ariche;S. Giachetti;D. Azoulay;D. Castaing;F. Kunstlinger;F. Lévi;F. Bismuth
背景：手术切除是结直肠肝转移最有效的治疗方法，但只有少数患者适合潜在治愈性切除。介绍了我们在新辅助化疗后切除的经验以及接受治疗的患者的五年生存分析。方法：1988年2月至1996年9月，701例不可切除的结直肠肝转移患者接受了新辅助化疗。不可切除的疾病被定义为四类：体积大、位置不良、多结节性和肝外疾病。对那些疾病可切除的患者进行了肝切除术。切除后，患者每3个月随访一次。对所描述的不同类别进行了 5 年生存分析。结果：95 名患者 (13.5%) 经重新评估发现可切除，并接受了可能治愈的切除。无围手术期死亡，并发症发生率为23%。截至1999年12月，已有87名患者完成了5年的随访。从切除时算起，总体 5 年生存率为 35%，从化疗开始算起，总体 5 年生存率为 39%。大肿瘤的 5 年生存率为 60%，位置不当的病灶为 49%，多结节病为 34%，伴肝外疾病的肝转移为 18%。然而，在后一类中，当分析所有肝外疾病的患者，而不仅仅是肝外疾病是不可切除的主要原因的患者时，发现 5 年生存率为 35%。结论：新辅助化疗使得一些最初无法切除的结直肠转移的患者能够进行肝切除。长期生存率与先验手术候选人的报告相似。
Background: Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented.Methods: Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed.Results: Ninety-five patients (13.5%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35% from the time of resection and 39% from the onset of chemotherapy. Respective 5-year survival rates are 60% for large tumors, 49% for ill-located lesions, 34% for multinodular disease, and 18% for liver metastases with extrahepatic disease. In this latter category, however, a 35% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability.Conclusions: Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates.