Early Recurrence After Hepatectomy for Colorectal Liver Metastases: What Optimal Definition and What Predictive Factors?
Early Recurrence After Hepatectomy for Colorectal Liver Metastases: What Optimal Definition and What Predictive Factors?
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DOI：
10.1634/theoncologist.2015-0468
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发表时间：
2016-07-01
期刊：
影响因子：
5.8
通讯作者：
Adam, Rene
中科院分区：
文献类型：
--
作者：
Imai, Katsunori;Allard, Marc-Antoine;Adam, Rene
背景本研究的目的是确定结直肠癌肝转移（CRLM）术后早期复发的最佳定义并阐明其预测因素。在1990年至2012年接受CRLM根治性手术的987例患者中，846例至少随访24个月的患者有资格参加本研究。首次复发后生存的最小p值方法用于确定早期复发定义的最佳截止值。分析早期复发的预测因素和影响生存的预后因素。对于667例（79%）复发的患者，早期复发的最佳截止点确定为术后8个月。早期复发对生存率的影响主要表现在接受术前化疗的患者中。在接受术前化疗的691例患者中，观察到562例（81%）复发，早期复发患者的生存率明显低于晚期复发患者（5年生存率18.5% vs. 53.4%，p <0.0001）。多变量逻辑分析确定年龄1化疗线（p = .03）、末线化疗期间疾病进展（p = .024）、>3个肿瘤（p = .0014）和碳水化合物抗原19-9.60 U/mL（p = .0003）是早期复发的独立预测因素。即使在早期复发的患者中，复发的挽救性手术也能显著提高生存率。早期复发的最佳截止点被确定为8个月。术前预测早期复发是可能的，并且对于设计有效的围手术期化疗方案至关重要。
Background. The purpose of this study was to determine the optimal definition and elucidate the predictive factors of early recurrence after surgery for colorectal liver metastases (CRLM).Methods. Among 987 patients who underwent curative surgery for CRLM from 1990 to 2012, 846 with a minimum follow-up period of 24 months were eligible for this study. The minimum p value approach of survival after initial recurrence was used to determine the optimal cutoff for the definition of early recurrence. The predictive factors of early recurrence and prognostic factors of survival were analyzed.Results. For 667 patients (79%) who developed recurrence, the optimal cutoff point of early recurrence was determined to be 8 months after surgery. The impact of early recurrence on survival was demonstrated mainly in patients who received preoperative chemotherapy. Among the 691 patients who received preoperative chemotherapy, recurrence was observed in 562 (81%), and survival in patients with early recurrence was significantly worse than in those with late recurrence (5-year survival 18.5% vs. 53.4%, p < .0001). Multivariate logistic analysis identified age 1 chemotherapy line (p = .03), disease progression during last-line chemotherapy (p = .024), >3 tumors (p = .0014), and carbohydrate antigen 19-9.60 U/mL (p = .0003) as independent predictors of early recurrence. Salvage surgery for recurrence significantly improved survival, even in patients with early recurrence.Conclusion. The optimal cutoff point of early recurrence was determined to be 8 months. The preoperative prediction of early recurrence is possible and crucial for designing effective perioperative chemotherapy regimens.