Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer.
Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer.
复制标题
DOI：
10.1056/nejm199912303412702
复制
发表时间：
1999-12-30
影响因子：
158.5
通讯作者：
Fong, YM
中科院分区：
文献类型：
--
作者：
Kemeny, N;Huang, Y;Fong, YM
背景：在接受结直肠癌肝转移切除术两年后，大约65%的患者还活着，25%的患者没有发现疾病。我们试图通过对肝切除术后肝动脉灌注氟尿嘧啶联合全身氟尿嘧啶的治疗来改善这些预后。方法：我们随机将156例结直肠癌肝转移切除患者随机分为6个周期，分别接受肝动脉灌注氟尿嘧啶和地塞米松联合静脉注射氟尿嘧啶，加或不加亚叶酸钙，或仅接受类似的全身治疗6周。根据以前的治疗和手术时发现的肝转移数量对患者进行分层。研究终点为总生存期、无肝转移复发生存期和两年无转移生存期。结果：联合治疗组两年总生存率为86%，单一治疗组为72%(P=0.03)。中位生存期联合治疗组为72.2个月，单一治疗组为59.3个月，中位随访期为62.7个月。两年后，联合治疗组和单纯治疗组的无肝复发生存率分别为90%和60%(P<0.001)，无进展生存率分别为57%和42%(P=0.07)。在调整了重要变量后，两年后，与接受综合治疗的患者相比，单独接受系统治疗的患者的死亡风险比为2.34(95%可信区间为1.1~4.98；P=0.027)。两组至少中度以上的不良反应发生率相似，但联合治疗组腹泻和肝脏反应的发生率较高。结论：对于结直肠癌肝转移癌切除患者，术后肝动脉灌注氟尿嘧啶和静脉注射氟尿嘧啶的联合治疗可改善两年的预后。(N Engl J Med 1999；341：2039-48)(C)1999年，马萨诸塞州医学会。
Background: Two years after undergoing resection of liver metastases from colorectal cancer, about 65 percent of patients are alive and 25 percent are free of detectable disease. We tried to improve these outcomes by treating patients with hepatic arterial infusion of floxuridine plus systemic fluorouracil after liver resection.Methods: We randomly assigned 156 patients at the time of resection of hepatic metastases from colorectal cancer to receive six cycles of hepatic arterial infusion with floxuridine and dexamethasone plus intravenous fluorouracil, with or without leucovorin, or six weeks of similar systemic therapy alone. Patients were stratified according to previous treatment and the number of liver metastases identified at operation. The study end points were overall survival, survival without recurrence of hepatic metastases, and survival without any metastases at two years.Results: The actuarial rate of overall survival at two years was 86 percent in the group treated with combined therapy and 72 percent in the group given monotherapy alone (P = 0.03). The median survival was 72.2 months in the combined-therapy group and 59.3 months in the monotherapy group, with a median follow-up of 62.7 months. After two years, the rates of survival free of hepatic recurrence were 90 percent in the combined-therapy group and 60 percent in the monotherapy group (P < 0.001), and the respective rates of progression-free survival were 57 percent and 42 percent (P = 0.07). At two years, the risk ratio for death was 2.34 among patients treated with systemic therapy alone, as compared with patients who received combined therapy (95 percent confidence interval, 1.10 to 4.98; P = 0.027), after adjustment for important variables. The rates of adverse effects of at least moderate severity were similar in the two groups, except for a higher frequency of diarrhea and hepatic effects in the combined-therapy group.Conclusions: For patients who undergo resection of liver metastases from colorectal cancer, postoperative treatment with a combination of hepatic arterial infusion of floxuridine and intravenous fluorouracil improves the outcome at two years. (N Engl J Med 1999;341:2039-48.) (C)1999, Massachusetts Medical Society.