A Survival Analysis of the Liver-First Reversed Management of Advanced Simultaneous Colorectal Liver Metastases A LiverMetSurvey-Based Study
A Survival Analysis of the Liver-First Reversed Management of Advanced Simultaneous Colorectal Liver Metastases A LiverMetSurvey-Based Study
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DOI：
10.1097/sla.0b013e3182734423
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发表时间：
2012-11-01
影响因子：
9
通讯作者：
Mentha, Gilles
中科院分区：
文献类型：
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作者：
Andres, Axel;Toso, Christian;Mentha, Gilles
背景：肝先行逆转治疗同时发生结直肠癌肝转移(CRLM)的患者包括肝定向化疗、切除CRLM以及随后切除原发癌。回顾数据显示，高达80%的患者可以成功地接受完整的RM，而在接受经典治疗(CM)的患者中，只有不到30%的患者可以成功完成RM。这项基于注册的研究比较了这两种方法。方法：这项研究基于利弗梅特调查(2000年1月1日至2010年12月31日)，包括有2个或更多转移的患者。所有患者在肝脏手术前都接受了伊立替康和/或奥沙利铂为主的化疗。结果：共纳入787例患者：CM组729例，RM组58例。两组患者转移数目相似(RM组和CM组分别为4.20vs4.80，P=0.231)，Fong评分均在3分以上(79%vs87%，P=0.164)。直肠癌、新辅助直肠放射治疗和伊立替康/奥沙利铂联合化疗在RM组中更常见(P<；0.001)，而在CM组中结直肠淋巴结受累更常见(P<；0.001)。RM组和CM组的总生存率和无瘤生存率相似(5年时分别为48%和46%，P=0.965和30%和26%，P=0.992)。结论：结直肠癌肝转移的经典和反向治疗成功后可获得相似的生存率。
Background: Liver-first reversed management (RM) for the treatment of patients with simultaneous colorectal liver metastases (CRLM) includes liver-directed chemotherapy, the resection of the CRLM, and the subsequent resection of the primary cancer. Retrospective data have shown that up to 80% of patients can successfully undergo a complete RM, whereas less than 30% of those undergoing classical management (CM) do so. This registry-based study compared the 2 approaches.Methods: The study was based on the LiverMetSurvey (January 1, 2000 to December 31, 2010) and included patients with 2 or more metastases. All patients had irinotecan and/or oxaliplatin-based chemotherapy before liver surgery. Patients undergoing simultaneous liver and colorectal surgery were excluded.Results: A total of 787 patients were included: 729 in the CM group and 58 in the RM group. Patients in the 2 groups had similar numbers of metastases (4.20 vs 4.80 for RM and CM, P = 0.231) and Fong scores of 3 or more (79% vs 87%, P = 0.164). Rectal cancer, neoadjuvant rectal radiotherapy, and the use of combined irinotecan/oxaliplatin chemotherapy were more frequent in the RM group (P < 0.001), whereas colorectal lymph node involvement was more frequent in the CM group (P < 0.001). Overall survival and disease-free survival were similar in the RM and CM groups (48% vs 46% at 5 years, P = 0.965 and 30% vs 26%, P = 0.992).Conclusions: Classical and reversed managements of metastatic liver disease in colorectal cancer are associated with similar survival when successfully completed.