Long-Term Outcomes of Conversion Hepatectomy for Initially Unresectable Colorectal Liver Metastases
Long-Term Outcomes of Conversion Hepatectomy for Initially Unresectable Colorectal Liver Metastases
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DOI：
10.1245/s10434-015-4460-0
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发表时间：
2016-02-01
影响因子：
3.7
通讯作者：
Hamada, Tomonori
中科院分区：
文献类型：
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作者：
Maeda, Yoshiaki;Shinohara, Toshiki;Hamada, Tomonori
包括分子靶向药物在内的化疗治疗转移性结直肠癌的方法最近有了很大的改善，并且为最初无法切除的肝转移患者提供了更多的转行肝切除术的机会。然而，转化性肝切除术的长期疗效仍有争议。我们回顾性评估了连续210例结直肠肝转移患者，以评估行转化性肝切除术患者的长期预后，并阐明与转换率相关的预测因素。94例最初可切除并行原发性肝切除术。在116例最初无法切除的肝转移患者中，104例患者接受了化疗（全身或肝动脉输注）。24%（11/46）最初不可切除的肝局限性转移瘤在化疗后可切除，随后接受转化性肝切除术治疗；然而，在肝外转移的患者中没有发生转化。最终肝转移灶切除率为50%(105/210)，包括转化性肝切除术。转行肝切除术组的5年预期生存率为76%。在肝局限性转移患者（24%）、未累及LN患者（27%）、肝动脉输注化疗组（33%）、抗egfr药物治疗组（21%）和完全或部分缓解患者（33%）中，转化率显著（P < 0.05）更高。24%的最初无法切除的肝局限性转移灶患者在化疗后可以切除，并且转归肝切除术后的生存率并不低于原发性肝切除术病例。需要高反应率的化疗方案来实现更高的转换率。
Chemotherapy, including molecular targeted agents, for metastatic colorectal cancer has greatly improved recently and offers an increased chance of conversion hepatectomy for patients with initially unresectable liver metastases. However, the long-term outcomes of conversion hepatectomy remain controversial.We retrospectively assessed a consecutive series of 210 patients with colorectal liver metastases to evaluate the long-term outcomes of patients who underwent conversion hepatectomy and to clarify the predictive factors related to the conversion rate.Ninety-four cases were initially resectable and underwent primary hepatectomy. Of the 116 patients with initially unresectable liver metastases, 104 patients underwent chemotherapy (systemic or hepatic artery infusion). Twenty-four percent (11/46) of the initially unresectable liver-limited metastases that became resectable after chemotherapy were subsequently treated with conversion hepatectomy; however, there were no cases of conversion among the patients with extrahepatic metastases. The final resection rate of liver metastases was 50 % (105/210), including conversion hepatectomies. The predicted 5-year survival rate in the conversion hepatectomy group was 76 %. The conversion rate was significantly (P < 0.05) higher in patients with liver-limited metastases (24 %), patients with no LN involvement (27 %), the hepatic arterial infusion chemotherapy group (33 %), patients treated with anti-EGFR agents (21 %), and patients with a complete or partial response (33 %).Twenty-four percent of the patients with initially unresectable liver-limited metastases became resectable after chemotherapy, and the survival rate after conversion hepatectomy was not inferior to that of the primary hepatectomy cases. Chemotherapy regimens with high response rates are needed to achieve a higher conversion rate.