A postoperative scoring system for post-hepatectomy early recurrence of colorectal liver metastases.
A postoperative scoring system for post-hepatectomy early recurrence of colorectal liver metastases.
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肝切除术后结直肠肝转移早期复发的术后评分系统
DOI：
10.18632/oncotarget.20934
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发表时间：
2017-11-24
期刊：
影响因子：
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通讯作者：
Cai JQ
中科院分区：
文献类型：
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作者：
Mao R;Zhao JJ;Bi XY;Zhang YF;Li ZY;Zhou JG;Wu XL;Xiao C;Zhao H;Cai JQ
本研究的目的是评估早期复发的预测因素，并阐明最佳的早期复发管理。方法回顾性分析255例结直肠癌肝转移（CRLM）患者的临床资料。共有87名患者（34.1%）发生了早期复发，定义为切除术后6个月内发生的复发。多因素分析显示，术前癌胚抗原（CEA）水平≥ 30 ng/ml、原发肿瘤淋巴管浸润（LVI）、转移灶数≥ 4个、R1切除和最初不能切除的疾病是早期复发的独立预测因素。通过合并这些因素，建立了早期复发的预测评分系统，该系统显示出良好的区分度（一致性指数为0.78）。在接受挽救治疗的早期复发患者中，具有0-2个风险因素的患者复发后的中位生存期显著长于具有3-5个风险因素的患者（33.4个月vs. 20.2个月，p = 0.001）。对于仅接受化疗的患者，两组复发后的中位生存期相当（18.3个月vs. 22.6个月，p = 0.926）。多因素分析显示原发肿瘤淋巴结转移（HR = 1.96，p = 0.032），早期复发（HR = 1.67，p = 0.045），复发的挽救治疗（HR = 0.47，p = 0.002）和早期复发预测评分（HR = 1.39，p = 0.004）是复发患者生存的独立因素。在早期复发患者中，转移灶的双叶分布（HR = 2.05，p = 0.025）和复发的挽救治疗（HR = 0.46，p = 0.019）是生存的独立因素。总之，我们开发了一个预测模型，这是一个非常有用的工具，用于确定早期复发的可能性和挽救治疗的必要性。
The aims of this study were to assess early recurrence predictive factors and elucidate the best early recurrence management. 255 patients with colorectal liver metastases (CRLM) who underwent hepatectomy were retrospectively analyzed. A total of 87 patients (34.1%) developed early recurrence, defined as recurrence that occurred within 6 months after resection. Multivariate analysis showed that preoperative carcino-embryonic antigen (CEA) level ≥ 30 ng/ml, primary tumor lymphovascular invasion (LVI), number of metastases ≥ 4, R1 resection and initially unresectable disease were independent predictors of early recurrence. A predictive scoring system for early recurrence was created by incorporating these factors, and this system showed good discrimination (concordance index of 0.78). In early recurrent patients who underwent salvage treatment, those with 0–2 risk factors demonstrated a significantly longer median survival after recurrence than patients with 3–5 risk factors (33.4 months vs. 20.2 months, p = 0.001). For patients who underwent chemotherapy alone, the median survival after recurrence between two groups was comparable (18.3 months vs. 22.6 months, p = 0.926). Multivariate analysis revealed that primary tumor lymph node metastases (HR = 1.96, p = 0.032), early recurrence (HR = 1.67, p = 0.045), salvage treatment for recurrence (HR = 0.47, p = 0.002) and predictive scores for early recurrence (HR = 1.39, p = 0.004) were independent factors for survival in patients with recurrence. In patients with early recurrence, bilobar distribution of metastases (HR = 2.05, p = 0.025) and salvage treatment for recurrence (HR = 0.46, p = 0.019) were independent factors for survival. In conclusion, we developed a predictive model that is a very useful tool for determining both the likelihood of early recurrence and the necessity for salvage treatment.