Conversion to Complete Resection and/or Ablation Using Hepatic Artery Infusional Chemotherapy in Patients with Unresectable Liver Metastases from Colorectal Cancer: A Decade of Experience at a Single Institution
Conversion to Complete Resection and/or Ablation Using Hepatic Artery Infusional Chemotherapy in Patients with Unresectable Liver Metastases from Colorectal Cancer: A Decade of Experience at a Single Institution
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DOI：
10.1245/s10434-013-3009-3
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发表时间：
2013-09-01
影响因子：
3.7
通讯作者：
D'Angelica, Michael I.
中科院分区：
文献类型：
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作者：
Ammori, John B.;Kemeny, Nancy E.;D'Angelica, Michael I.
在可行的情况下，手术治疗结直肠癌肝转移（CRLM）是治疗的选择。区域性肝动脉灌注（HAI）化疗可有效治疗CRLM。HAI和全身化疗的组合可以缩小肿瘤并允许完全切除和/或消融（R/A）。本研究分析了HAI和全身化疗联合治疗不可切除CRLM的情况，重点是转为完全R/A。纳入了2000年至2009年接受HAI和全身化疗治疗的所有不可切除CRLM患者。将反应足以接受完全R/A的患者与未转换的患者进行比较。采用里程碑分析比较生存率以解释偏倚，共纳入373例患者; 93例患者（25%）随后接受了完全R/A。提交完成R/A的患者百分比从2000-2003年的16%增加到2004-2009年的30%。多变量分析中与转换相关的因素是最近的治疗（2004-2009年），既往未接受化疗，临床风险评分< 3，临床方案治疗和年轻。在转为完全R/A的患者中，从HAI泵置入开始的中位和预测5年生存期分别为59个月和47%，而在未转为完全R/A的患者中，分别为16个月和6%。（p < 0.001）。尽管疾病广泛，25%的不可切除CRLM患者在HAI加全身化疗后充分缓解，接受完全R/A。联合HAI和全身化疗是一种有效的策略，可以使患者完全切除，并获得良好的长期生存率。
When feasible, surgical treatment of colorectal liver metastases (CRLM) is the treatment of choice. Regional hepatic artery infusional (HAI) chemotherapy effectively treats CRLM. The combination of HAI and systemic chemotherapy may downsize tumors and allow for complete resection and/or ablation (R/A). This study analyzes the combination of HAI and systemic chemotherapy for treating unresectable CRLM, focusing on conversion to complete R/A.All patients with unresectable CRLM treated with HAI and systemic chemotherapy from 2000 to 2009 were included. Patients who responded sufficiently to undergo complete R/A were compared to those who did not convert. Survival was compared using a landmark analysis to account for bias.A total of 373 patients were included; 93 patients (25 %) subsequently underwent complete R/A. The percentage of patients submitted to complete R/A increased from 16 % during 2000-2003 to 30 % during 2004-2009. Factors associated with conversion on multivariate analysis were more recent treatment (2004-2009), no prior chemotherapy, clinical risk score < 3, treatment on clinical protocol, and younger age. Median and predicted 5-year survival from the time of HAI pump placement was 59 months and 47 %, respectively, in the patients who converted to complete R/A, compared with 16 months and 6 %, respectively in those who did not (p < 0.001).Despite extensive disease, 25 % of patients with unresectable CRLM responded sufficiently to undergo complete R/A following HAI plus systemic chemotherapy. Combination HAI and systemic chemotherapy is an effective strategy to convert patients to complete resection with an associated excellent long-term survival.