Complete response of colorectal liver metastases after chemotherapy:: Does it mean cure?
Complete response of colorectal liver metastases after chemotherapy:: Does it mean cure?
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DOI：
10.1200/jco.2006.05.8727
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发表时间：
2006-08-20
影响因子：
45.3
通讯作者：
Nordlinger, Bernard
中科院分区：
文献类型：
--
作者：
Benoist, Stephane;Brouquet, Antoine;Nordlinger, Bernard
目的：大多数结直肠肝转移（LMs）患者接受全身化疗。本研究旨在确定化疗后LMs影像学完全缓解的意义。患者和方法1998年至2004年间，586例患者在同一机构接受了结肠直肠癌治疗。其中，38例符合以下标准的患者被纳入研究：化疗前LMs少于10例；计算机断层扫描（CT）和超声显示一个或多个LMs消失；术中超声在4周内显像；无肝外疾病；术后随访至少1年。结果CT扫描显示化疗后LMs消失66例。尽管CT扫描显示完全缓解，但在66例LMs中有20例手术部位观察到持续的宏观疾病。15例初始LMs在手术中不可见的部位被切除。病理检查认为这些部位的LMs完全缓解，15例中有12例存在活的癌细胞。31个初始LMs在手术中不可见的部位在手术中被保留；随访1年后，31例完全缓解的LMs中有23例原位复发。总体而言，66例LMs中影像学完全缓解的55例（83%）观察到持续的宏观或微观残留疾病或早期原位复发。结论在大多数接受化疗的结肠直肠癌患者中，CT扫描完全缓解并不意味着治愈。
Purpose Most patients with colorectal liver metastases (LMs) receive systemic chemotherapy. This study aimed to determine the significance of a complete response on imaging of LMs after chemotherapy.Patients and Methods Between 1998 and 2004, 586 patients were treated for colorectal LMs in one institution. Of these, 38 with the following criteria were included in the study: fewer than 10 LMs before chemotherapy; disappearance of one or several LMs on computed tomography (CT) scan and ultrasound; surgery with intraoperative ultrasound within 4 weeks of imaging; no extrahepatic disease; follow-up at least 1 year after surgery.Results Overall, 66 LMs disappeared after chemotherapy as seen on CT scan. Persistent macroscopic disease was observed at surgery at the site of 20 of 66 LMs, despite CT scan showing a complete response. The sites of 15 initial LMs that were not visible at surgery were resected. Pathologic examination of these sites of LMs, considered in complete response, showed viable cancer cells present in 12 of 15 cases. The sites of 31 initial LMs that were not visible at surgery were left in place during surgery; after 1 year of follow-up, 23 of 31 LMs considered in complete response had recurred in situ. Overall, persistent macroscopic or microscopic residual disease or early recurrence in situ were observed in 55 (83%) of 66 LMs having a complete response on imaging.Conclusion In most patients receiving chemotherapy for colorectal LMs, a complete response on CT scan does not mean cure.