Long-term outcomes of patients with 10 or more colorectal liver metastases
Long-term outcomes of patients with 10 or more colorectal liver metastases
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DOI：
10.1038/bjc.2017.218
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发表时间：
2017-08-22
影响因子：
8.8
通讯作者：
Figueras, J.
中科院分区：
文献类型：
--
作者：
Allard, M. A.;Adam, R.;Figueras, J.
背景资料：虽然结直肠肝转移（CLM）的数量越来越少地被认为是手术的禁忌症，但10个CLM或更多的患者通常拒绝肝脏手术。本研究旨在评估肝脏手术后的结果，并确定此类患者生存的预后因素。（N = 12 406）从2005年1月至2013年6月期间进行了手术，并打算切除，其数据前瞻性地收集在LiverMetSurvey登记处。总体而言，≥ 10例CLM患者（N = 529，4.3%）的5年总生存率（OS）为30%。肉眼完全（R 0/R1）切除（72.8%的患者）的3年和5年OS分别为61%和39%，而R2/未切除患者的OS分别为29%和5%（P < 0.0001）。在多变量分析中，R 0/R1切除是OS最有利的因素（HR 0.35（0.26-0.48））。其他独立有利因素如下：最大肿瘤大小< 40 mm（HR 0.67（0.49-0.92））;年龄< 60岁（HR 0.66（0.50-0.88））;术前MRI（HR 0.65（0.47-0.89））;辅助化疗（HR 0.73（0.55-0.98））。该模型显示，5年OS率为30%是可能提供R 0/R1切除术与至少一个额外的有利factor.Conclusions：肝切除术可能提供长期生存的患者>= 10 CLM分期与术前MRI，提供R 0/R1切除术后辅助治疗。需要在另一个队列中验证这些结果。
Background: Although the number of colorectal liver metastases (CLM) is decreasingly considered as a contraindication to surgery, patients with 10 CLM or more are often denied liver surgery. This study aimed to evaluate the outcome after liver surgery and to identify prognostic factors of survival in such patients.Methods: The study population consisted of a multicentre cohort of patients with CLM (N = 12 406) operated on, with intention to resect, from January 2005-June 2013 and whose data were prospectively collected in the LiverMetSurvey registry.Results: Overall, the group >= 10 CLM (N = 529, 4.3%) experienced a 5-year overall survival (OS) of 30%. A macroscopically complete (R0/R1) resection (72.8% of patients) was associated with a 3- and 5-year OS of 61% and 39% vs 29% and 5% for R2/no resection patients (P < 0.0001). At multivariate analysis, R0/R1 resection emerged as the strongest favourable factor of OS (HR 0.35 (0.26-0.48)). Other independent favourable factors were as follows: maximal tumour size < 40 mm (HR 0.67 (0.49-0.92)); age < 60 years (HR 0.66 (0.50-0.88)); preoperative MRI (HR 0.65 (0.47-0.89)); and adjuvant chemotherapy (HR 0.73 (0.55-0.98)). The model showed that 5-year OS rates of 30% was possible provided R0/R1 resection associated with at least an additional favourable factor.Conclusions: Liver resection might provide long-term survival in patients with >= 10 CLM staged with preoperative MRI, provided R0/R1 resection followed by adjuvant therapy. A validation of these results in another cohort is needed.