Timing of surgery in patients with synchronous colorectal cancer liver metastases undergoing neoadjuvant chemotherapy: a propensity score analysis.
Timing of surgery in patients with synchronous colorectal cancer liver metastases undergoing neoadjuvant chemotherapy: a propensity score analysis.
复制标题
DOI：
10.1186/s12957-023-03162-y
复制
发表时间：
2023-09-01
影响因子：
3.2
通讯作者：
Cheng, Nansheng
中科院分区：
文献类型：
--
作者：
Wang, Yaoqun;Wen, Ningyuan;Xiong, Xianze;Lu, Jiong;Li, Bei;Cheng, Nansheng
关键词：
同步结直肠癌肝转移(SLM)患者接受新辅助化疗(NAC)后的最佳手术时机仍存在争议。我们计划分析不同手术时机的选择是否会对患者的围手术期和肿瘤学结果产生不同的影响。我们回顾收集了2010年至2020年在西中国医院符合纳入和排除标准的所有患者。根据NAC至手术的时间间隔(TI)对患者进行分组。在倾向评分匹配后，比较两组的围手术期和肿瘤学结果。采用单因素和多因素分析筛选与预后相关的因素。在255名登记的患者中，188人与可比基线匹配(每组94人)。6≦TI≦8组手术时间长，术中出血量少，术后并发症少，与4≦TI 和 6组比较，差异有统计学意义(P<0.05)。而4≦TI + 6组患者的总生存期(OS)(p≦0.012)和无病生存期(DFS)(p≦0.013)均好于6 TI 8组。亚组分析发现，上述结论仍然适用于60岁的 ≥ 患者、非贫血患者和接受R0切除的患者。在术前无黄疸的患者中，OS与TI呈负相关。术前有黄褐者DFS与TI呈负相关。多因素分析显示，NAC手术后TI延长是OS和DFS的独立预后危险因素。SLM患者在接受NAC治疗后4-6周内可能是更好的手术选择。尽管在NAC后4-6周接受手术的SLM患者术后并发症发生率较高，但为获得更好的生存效益，仍建议进行根治性手术。网上版载有补充材料，可在10.1186/s12957-023-03162-y查阅。
The optimal timing of surgery after neoadjuvant chemotherapy (NAC) in patients with synchronous colorectal cancer liver metastases (SLM) remains controversial. We plan to analyze whether the choice of different surgical timings will have different effects on the perioperative and oncologic outcomes of patients. We retrospectively collected all patients who met the inclusion and exclusion criteria from 2010 to 2020 in West China Hospital. Patients were grouped according to time interval (TI) after NAC to surgery. The perioperative and oncologic outcomes of the two groups were compared after propensity score matching. Univariate and multivariate analyzes were used to screen factors associated with prognosis. Among 255 enrolled patients, 188 were matched with comparable baseline (94 each group). Patients in the 6≦TI≦8 group had longer operation time, less intraoperative blood loss, and less postoperative complications than those in the 4≦TI < 6 group. However, the overall survival (OS) (p = 0.012) and disease-free survival (DFS) (p = 0.013) of the patients in the 4≦TI < 6 group were better than those in the 6≦TI≦8 group. Subgroup analysis found that the above conclusions still apply in age ≥ 60, non-anemic patients, and patients who underwent R0 resection. OS was inversely correlated with TI in patients without preoperative jaundice. DFS was negatively correlated with TI in patients with preoperative jaundice. Multivariate analysis showed that the prolongation of TI after NAC to surgery was an independent prognostic risk factor for OS and DFS. Patients with SLM may be a better choice for surgery within 4–6 weeks after receiving NAC. Although patients with SLM undergoing surgery 4–6 weeks after NAC has a higher rate of postoperative complications, radical surgery is still recommended for a better survival benefit. The online version contains supplementary material available at 10.1186/s12957-023-03162-y.
登录
查看更多内容
影响因子：
3.7
作者：
Rombouts AJM;Hugen N;Elferink MAG;Nagtegaal ID;de Wilt JHW
通讯作者：
de Wilt JHW
影响因子：
2.7
作者：
Noda, Takehiro;Takahashi, Hidekazu;Tei, Mitsuyoshi;Nishida, Naohiro;Hata, Taishi;Takeda, Yutaka;Ohue, Masayuki;Wada, Hiroshi;Mizushima, Tsunekazu;Asaoka, Tadafumi;Uemura, Mamoru;Kobayashi, Shogo;Murata, Kohei;Satoh, Taroh;Doki, Yuichiro;Eguchi, Hidetoshi
通讯作者：
Eguchi, Hidetoshi
DOI：
10.3760/cma.j.cn441530-20221229-00542
发表时间：
2023-01-01
期刊：
Chinese Journal of Gastrointestinal Surgery
影响因子：
--
作者：
Chinese College of Surgeons;Section of Gastrointestinal Surgery,Branch of Surgery,Chinese Medical Association;Branch of Colorectal Disease,China International Exchange and Promotive Association for Medical and Health Care
通讯作者：
Branch of Colorectal Disease,China International Exchange and Promotive Association for Medical and Health Care
影响因子：
5.8
作者：
Hurwitz, Herbert, I;Tan, Benjamin R.;Bendell, Johanna
通讯作者：
Bendell, Johanna
影响因子：
3.8
作者：
Lai, Valerie;Hajjaj, Omar;Simmons, Christine
通讯作者：
Simmons, Christine