Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma.
Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma.
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DOI：
10.1186/1471-2407-14-810
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发表时间：
2014-11-04
期刊：
影响因子：
3.8
通讯作者：
Schlitt HJ
中科院分区：
文献类型：
--
作者：
Hackl C;Neumann P;Gerken M;Loss M;Klinkhammer-Schalke M;Schlitt HJ
本研究的目的是使用德国肿瘤登记处的数据，分析10年内诊断为结直肠肝转移（CLM）患者的手术治疗和长期临床结局。回顾性分析2002年至2007年5772例结直肠腺癌患者。随访一直持续到2012年。CLM 1426例（24.7%），同时性CLM 1019例（71%），异时性CLM 407例（29%）。1426例CLM患者中有374例（26%）进行了肝切除。观察到肝切除率从2002年队列的16.6%显著增加到后来队列的32%。在肝脏外科专业中心，CLM切除率达到46.6%。然而，高达52%的被诊断患有三个或更少CLM的患者没有接受肝脏手术，尽管如果切除，患有1个CLM的患者显示出与没有发展任何CLM的CRC患者相似的长期生存。经年龄、性别、切除年份、CLM诊断时间和CLM数量校正的单变量和多变量分析显示，CLM切除术具有显著的生存获益（HR =0.355; CI 0.305-0.414）。此外，诊断时的年龄、围手术期化疗和CLM数量对OS有显著影响。我们在此首次对德国CLM的外科治疗进行了长期的、以人群为基础的分析。多年来观察到肝切除率显著增加，转化为OS的显著获益。然而，我们仍然看到了跨学科CLM管理进一步改善的惊人潜力。本文的在线版本（doi：10.1186/1471-2407-14-810）包含补充材料，可供授权用户使用。
Purpose of this study was to analyse the surgical management and long-term clinical outcome of patients diagnosed with colorectal liver metastases (CLM) over a period of 10 years using data from a German tumour registry. Retrospective analysis of 5772 patients diagnosed with colorectal adenocarcinoma between 2002 and 2007. Follow-up was continued until 2012. 1426 patients (24.7%) had CLM; 1019 patients (71%) had synchronous, 407 patients (29%) developed metachronous CLM. Hepatic resection was performed in 374 of the 1426 CLM patients (26%). A significant increase in liver resection rate from 16.6% for the 2002 cohort to 32% in later cohorts was observed. In centers specialized in liver surgery, CLM resection rates reached 46.6%. However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM. Univariate and multivariate analyses adjusted for age, sex, year of resection, time of CLM diagnosis and number of CLM revealed a significant survival benefit for CLM resection (HR =0.355; CI 0.305-0.414). Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM. We here present the first long-term, population-based analysis of the surgical management of CLM in Germany. Significant increase in hepatic resection rates, translating to a significant benefit in OS, was seen over years. However, we still see a striking potential for further improvements in interdisciplinary CLM management. The online version of this article (doi:10.1186/1471-2407-14-810) contains supplementary material, which is available to authorized users.
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