Posttreatment Surveillance in Patients with Prolonged Disease-Free Survival After Resection of Colorectal Liver Metastasis.
Posttreatment Surveillance in Patients with Prolonged Disease-Free Survival After Resection of Colorectal Liver Metastasis.
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DOI：
10.1245/s10434-016-5388-8
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发表时间：
2016-11
影响因子：
3.7
通讯作者：
Verhoef C
中科院分区：
文献类型：
--
作者：
Galjart B;van der Stok EP;Rothbarth J;Grünhagen DJ;Verhoef C
治疗后监测方案通常在结直肠肝转移瘤(CRLM)切除后持续5年。大多数复发发生在手术切除肿瘤后的3年内。这项研究分析了对CRLM切除后至少3年无病生存的患者进行监测的必要性。对2000至2011年间连续接受CRLM治疗的所有患者进行单中心回顾性分析。总体而言，545名患者中有152名(28%)在成功切除CRLM后3年内保持无病状态。在这组152名患者中，经过10年的随访，估计复发率为27%。超过一半的患者(55%)可以根据复发的治疗意图进行治疗。多变量分析显示，原发肿瘤的结节状态对3年无病生存后复发有显著的预后价值。从原发肿瘤切除到CRLM检查的无病间隔不到12个月，显示出有意义的趋势。这两个因素都被用来创建风险评分，显示具有低风险特征(节点阴性状态和无病间隔12个月)的患者估计复发率为5%，并且可能不会从超过3年的随访而没有复发的密集监测中受益。目前开发的风险评分显示，在具有治疗意图的CRLM治疗3年后，可以在特定的亚组中停止随访。本文的在线版本(doi：10.1245/s10434-0165388-8)包含补充材料，授权用户可以使用。
Posttreatment surveillance protocols most often endure for 5 years after resection of colorectal liver metastasis (CRLM). Most recurrences happen within 3 years after surgical removal of the tumour. This study analysed the need of surveillance for patients with at least 3 years of disease-free survival after potentially curative resection of CRLM. A single-centre, retrospective analysis of all consecutive patients who underwent treatment for CRLM with curative intent between 2000 and 2011. In total, 152 of 545 patients (28 %) remained disease-free for 3 years after successful resection of the CRLM. The estimated recurrence rate after 10 years of follow-up in this group of 152 patients was 27 %. More than half of these patients (55 %) could be treated with curative intent for their recurrences. Multivariable analysis revealed that the nodal status of the primary tumour is of significant prognostic value for developing recurrences after 3 years of disease-free survival. A disease-free interval of less than 12 months between resection of primary tumour and detection of CRLM shows a trend towards significance. Both factors were used to create a risk score, showing that patients with a low-risk profile (node-negative status and a disease-free interval <12 months) have an estimated recurrence rate of 5 % and might not benefit from intensive surveillance beyond 3 years of follow-up without a recurrence. The currently developed risk score shows that follow-up can be stopped in a specific subgroup 3 years after treatment for their CRLM with curative intent. The online version of this article (doi:10.1245/s10434-016-5388-8) contains supplementary material, which is available to authorized users.
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