Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Francaise de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis
Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Francaise de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis
复制标题
DOI：
10.1007/s00268-018-4711-x
复制
发表时间：
2018-12-01
影响因子：
2.6
通讯作者：
Azoulay, Daniel
中科院分区：
文献类型：
--
作者：
Esposito, Francesco;Lim, Chetana;Azoulay, Daniel
目的比较逆行策略（RS）与经典策略（CS）治疗IVA期单肝结直肠癌（CCR）的多中心研究很少。本研究的目的是比较使用CS和rs后的长期生存和复发模式。方法本回顾性多中心综述收集了2006年至2013年法国24家医院分期切除CCR和肝转移（LM）的所有IVA期仅肝CCR连续患者的数据，并进行回顾性分析。同时行肝和CCR切除术的患者，同步肝外转移的患者，以及紧急CCR切除术的患者均被排除在外。研究倾向评分匹配（PSM）前后的总生存率（OS）、无复发生存率（RFS）和复发模式。结果共纳入653例患者：CS组587例（89.9%），RS组66例（10.1%）。与CS患者相比，RS患者更容易发生直肠癌（43.9比24.9%,p=0.006），肝肿瘤大小更大（52.538.6比39.6 +/- 30mm, p=0.01），淋巴结阳性（62.1比44.8%,p=0.009）。两组间OS差异无统计学意义（75 vs 72%, p=0.77），而RS组的RFS更差（24 vs 33%, p=0.01）。RS组任何部位复发时间（1.8年vs. 2.4年，p=0.024）和肝内复发时间（1.7年vs. 2.2年，p=0.014）均显著短于CS组。PSM后（每组63例），两组在OS （p=0.35）、RFS （p=0.62）、任何部位复发时间（p=0.19）和肝内复发（p=0.13）方面无显著差异。在本研究中，大约10%的CCR和同步LM患者接受了RS手术，两种策略确保了相似的肿瘤预后。
ObjectivesMulticenter studies comparing the reverse strategy (RS) with the classical strategy (CS) for the management of stage IVA liver-only colorectal cancer (CCR) are scarce. The aim of this study was to compare long-term survival and recurrence patterns following use of the CS and RS.MethodThis retrospective multicenter review collected data from all consecutive patients with stage IVA liver-only CCR who underwent staged resection of CCR and liver metastases (LM) at 24 French hospitals between 2006 and 2013 and were retrospectively analyzed. Patients who underwent simultaneous liver and CCR resection, those with synchronous extrahepatic metastasis, and those who underwent emergent CCR resection were excluded. Overall survival (OS) and recurrence-free survival (RFS) rates and recurrence patterns were investigated before and after propensity score matching (PSM).ResultsA total of 653 patients were included: 587 (89.9%) in the CS group and 66 (10.1%) in the RS group. Compared with the CS patients, RS patients were more likely to have rectal cancer (43.9 vs. 24.9%; p=0.006), larger liver tumor size (52.538.6 vs. 39.6 +/- 30mm; p=0.01), and more positive lymph nodes (62.1 vs. 44.8%; p=0.009). OS was not different between the two groups (75 vs. 72% at 5years; p=0.77), while RFS was worse in the RS group (24 vs. 33% at 5years; p=0.01). Time to recurrence at any site (1.8 vs. 2.4years, p=0.024) and intrahepatic recurrence (1.7 vs. 2.2years, p=0.014) were significantly shorter in the RS group than in the CS group. After PSM (63 patients in each group), no significant difference was found between the two groups in OS (p=0.35), RFS (p=0.62), time to recurrence at any site (p=0.19), or intrahepatic recurrence (p=0.13).Conclusions In this study, approximately 10% of patients with CCR and synchronous LM were offered surgery with the RS. Both strategies ensured similar oncological outcomes.