Time-to-Surgery and Survival Outcomes in Resectable Colorectal Liver Metastases: A Multi-Institutional Evaluation.
Time-to-Surgery and Survival Outcomes in Resectable Colorectal Liver Metastases: A Multi-Institutional Evaluation.
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DOI：
10.1016/j.jamcollsurg.2016.01.046
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发表时间：
2016-05
影响因子：
5.2
通讯作者：
Jarnagin WR
中科院分区：
文献类型：
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作者：
Leal JN;Bressan AK;Vachharajani N;Gonen M;Kingham TP;D'Angelica MI;Allen PJ;DeMatteo RP;Doyle MB;Bathe OF;Greig PD;Wei A;Chapman WC;Dixon E;Jarnagin WR
切除结直肠癌肝转移(CRLM)与提高存活率有关；然而，切除时间对存活率的影响尚不清楚。目前的多机构研究试图评估从诊断到切除的时间(Dx-Rx)对可切除的异时性CRLM患者生存结果的影响，并比较不同医院的实践模式。回顾分析≤-4异时性CRLM4例手术治疗的病历资料。从Dx-Rx开始的时间作为连续变量进行分析，并将其分为两组[Dx-Rx<；3个月(组1)，Dx-Rx≥3个月(组2)]进行进一步分析。术后生存时间分布采用Kaplan-Meier方法估计。组间比较采用对数列检验，多因素分析采用COX比例风险模型。从2000-2010年间，确定了626名患者。不同医院的初始转诊类型(P<；0.0001)和新辅助化疗(P<；0.0001)的使用情况有显著差异。接受新辅助化疗的患者(n=108)和在开腹手术时不能切除的疾病(n=5)被排除在最终评估之外。中位总(OS)和无复发(RFS)生存期分别为74(63.8-84.2)个月和29(23.9-34.1)个月。在整个队列中，从Dx-Rx开始的时间较长独立地与较短的OS[危险比(HR)，95%可信区间(CI)]相关(HR1.12，95%可信区间1.06-1.18，p<；0.0001)，但与RFS无关。第1组的中位OS为76(62.0-89.2)个月，而第2组为58(34.3-81.7)个月，p=0.10。在有关于辅助化疗(n=457；接受治疗的318例，未治疗的139例)、OS[87(71.2-102.8)个月对48(25.3-70.7)个月，p<；0.0001]和RFS[33(25.3-40.7)对22(14.5-29.5)个月，p=0.0001]的患者中，显著改善。在选择接受CRLM初始切除的患者中，从Dx-Rx开始的时间较长与较差的OS独立相关。此外，尽管疾病特征一致，但与明确可切除的CRLM相关的实践模式在不同医院之间存在显著差异。
Resection of colorectal liver metastases(CRLM) is associated with improved survival; however, the impact of time to resection on survival is unknown. The current multi-institutional study sought to evaluate the influence of time from diagnosis to resection(Dx-Rx) on survival outcomes among patients with resectable, metachronous CRLM and to compare practice patterns across hospitals. Medical records of patients with ≤ 4 metachronous CRLM treated with surgery were reviewed and analyzed retrospectively. Time from Dx-Rx, was analyzed as a continuous variable and also dichotomized into two groups [Dx-Rx<3 months (Group 1), Dx-Rx≥ 3months (Group 2)] for further analysis. Survival time distributions after resection were estimated using the Kaplan-Meier method. Between group univariate comparisons were based on the log-rank test and multivariable analysis was done using Cox-proportional hazards model. From 2000-2010, 626 patients were identified. Type of initial referral(p<0.0001) and use of neoadjuvant(p=0.04) and/or adjuvant (p<0.0001)chemotherapy were significantly different among hospitals. Patients treated with neoadjuvant chemotherapy(n=108) and those with unresectable disease at laparotomy(n=5) were excluded from final evaluation. Median overall(OS) and recurrence free(RFS) survival [median(min-max)] were 74(63.8-84.2)months and 29(23.9-34.1)months, respectively. For the entire cohort, longer time from Dx-Rx was independently associated with shorter OS[Hazard ratio(HR), 95% Confidence Interval(CI)];(HR 1.12, 95% CI 1.06-1.18, p<0.0001) but not RFS. Median OS for Group 1 was 76(62.0-89.2)months vs. 58(34.3-81.7) months in Group 2, p=0.10. Among patients with available data pertaining to adjuvant chemotherapy (n=457; 318 treated, 139 untreated), OS[87(71.2-102.8) vs. 48(25.3-70.7) months, p<0.0001] and RFS[33(25.3-40.7) vs. 22(14.5-29.5) months, p=0.05]were significantly improved. In select patients undergoing initial resection for CRLM, longer time from Dx-Rx is independently associated with worse OS. Furthermore, despite uniform disease characteristics, practice patterns related to definitely resectable CRLM vary significantly across hospitals.