Pathologic Response to Preoperative Chemotherapy: A New Outcome End Point After Resection of Hepatic Colorectal Metastases
Pathologic Response to Preoperative Chemotherapy: A New Outcome End Point After Resection of Hepatic Colorectal Metastases
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DOI：
10.1200/jco.2008.17.5299
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发表时间：
2008-11-20
影响因子：
45.3
通讯作者：
Vauthey, Jean-Nicolas
中科院分区：
文献类型：
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作者：
Blazer, Dan G., III;Kishi, Yoji;Vauthey, Jean-Nicolas
目的本研究的主要目的是评估结直肠癌肝转移（CLM）患者术前化疗和切除术后对化疗的病理反应是否能预测患者的生存率。这项研究的次要目标是确定临床预测的病理respons.Patients和MethodsA回顾性分析进行了305例谁接受术前伊立替康或奥沙利铂为基础的化疗，然后切除CLM。系统评价病理学缓解，并报告为每个肿瘤内残留癌细胞百分比的平均值。进行单变量和多变量分析以确定病理反应和生存的预测因素。结果按病理反应状态列出的累积5年总生存率如下：75%完全缓解（无残留癌细胞），56%主要缓解（1%至49%残留癌细胞）和33%轻微反应（>= 50%残留癌细胞;完全反应vs主要反应，P = 0.037;主要反应vs轻微反应，P = 0.028）。多变量分析显示，只有手术切缘状态（P = 0.050;风险比[HR]，1.77）和病理反应（主要反应：P = 0.034; HR，4.80;次要反应：P = 0.007; HR，6.93）是生存的独立预测因素。病理反应预测因素的多变量分析显示，癌胚抗原水平
PurposeThe primary goal of this study was to evaluate whether pathologic response to chemotherapy predicts patient survival after preoperative chemotherapy and resection of colorectal liver metastases (CLM). The secondary goal of the study was to identify the clinical predictors of pathologic response.Patients and MethodsA retrospective review was performed of 305 patients who underwent preoperative irinotecan- or oxaliplatin-based chemotherapy, followed by resection of CLM. Pathologic response was systematically evaluated and reported as the mean of the percentage of cancer cells remaining within each tumor. Univariate and multivariate analyses were performed to identify the predictors of pathologic response and survival.ResultsCumulative 5-year overall survival rates by pathologic response status were as follows: 75% complete response (no residual cancer cells), 56% major response (1% to 49% residual cancer cells), and 33% minor response (>= 50% residual cancer cells; complete v major response, P = .037; major v minor response, P = .028). Multivariate analysis revealed that only surgical margin status (P = .050; hazard ratio [HR], 1.77) and pathologic response (major response: P = .034; HR, 4.80; minor response: P = .007; HR, 6.93) were independent predictors of survival. Multivariate analysis of the predictors of pathologic response revealed that carcinoembryonic antigen level