Chemotherapy and Targeted Therapy for Patients with Initially Unresectable Colorectal Liver Metastases, Focusing on Conversion Hepatectomy and Long-Term Survival
Chemotherapy and Targeted Therapy for Patients with Initially Unresectable Colorectal Liver Metastases, Focusing on Conversion Hepatectomy and Long-Term Survival
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DOI：
10.1245/s10434-014-3577-x
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发表时间：
2014-06-01
影响因子：
3.7
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
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作者：
Beppu, Toru;Miyamoto, Yuji;Baba, Hideo
自从引入化疗(化疗)和靶向治疗方案治疗结直肠癌肝转移(CRLM)以来，已经过去了八年。本研究旨在阐明化疗和靶向治疗在促进日本CRLM患者中转肝切除和提高长期存活率方面的有效性。2005年5月至2012年8月期间，共有199名CRLM患者接受了治疗。这些患者的初始治疗包括直接肝切除(n=48；24%)、诱导化疗(n=148；74%)和射频消融(n=3；2%)。在最初不能切除的137例患者中，56例(40.1%)接受了7.5个疗程的化疗和靶向治疗，肿瘤缩小并转化为可切除的肿瘤。可切除组的5年累积总生存率(OS)和中位生存期显著高于不能切除组(分别为54.6%比5.3%和77.3%比21.3个月；P<；0.0001)。多因素分析显示，中转肝切除(风险比[HR]0.19；P<；.001)和对化疗和靶向治疗的反应(HR；0.46；P<；.01)是OS的独立预后因素。多因素分析还显示，左侧结肠癌或直肠癌(优势比[OR]8.4；P<；0.05)、H1/H2转移(OR 7.3；P<；0.05)、无肝外转移(OR 52.6；P<；.001)、化疗和靶向治疗有效(OR 6.1；P<；0.05)是中转肝切除的重要预测因素。化疗和靶向治疗可以促进中转肝切除，使最初不能切除的CRLM患者获得良好的预后。
Eight years have passed since the introduction of chemotherapy (chemo) and targeted therapy regimens for colorectal liver metastases (CRLM). This study aimed to clarify the effectiveness of chemo and targeted therapy in facilitating conversion hepatectomy and improving long-term survival in Japanese patients with CRLM.A total of 199 patients with CRLM were treated between May 2005 and August 2012. Initial therapies for these patients included straightforward hepatic resection (n = 48; 24 %), induction chemotherapy (n = 148; 74 %), and radiofrequency ablation (n = 3; 2 %).In 56 of 137 patients (40.1 %) with initially unresectable CRLM, 7.5 courses of chemo and targeted therapy downsized and converted tumors to resectable tumors. The 5-year cumulative overall survival (OS) rate and the median survival time were significantly higher for the resectable CRLM than for the unresectable CRLM (54.6 vs. 5.3 % and 77.3 vs. 21.3 months, respectively; P < .0001). Multivariate analysis revealed that conversion hepatectomy (hazard ratio [HR] 0.19; P < .001) and responder to chemo and targeted therapy (HR 0.46; P < .01) were independent prognostic factors for OS. Multivariate analysis also revealed that left-sided colon or rectal cancer (odds ratio [OR] 8.4; P < .05), H1/H2 metastases (OR 7.3; P < .05), no extrahepatic metastases (OR 52.6; P < .001), and responder to chemo and targeted therapy (OR 6.1; P < .05) were significant predictors of conversion hepatectomy.A chemo and targeted therapy can facilitate conversion hepatectomy and allow for an excellent prognosis in patients with initially unresectable CRLM.