Actual 10-year survival after resection of colorectal liver Metastases defines cure
Actual 10-year survival after resection of colorectal liver Metastases defines cure
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DOI：
10.1200/jco.2007.11.0833
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发表时间：
2007-10-10
影响因子：
45.3
通讯作者：
D'Angelica, Michael
中科院分区：
文献类型：
--
作者：
Tomlinson, James S.;Jarnagin, William R.;D'Angelica, Michael
目的在过去的20年中，在特定患者中切除结直肠癌肝转移(CLM)已逐渐成为治疗的标准。在缺乏前瞻性随机临床试验的情况下，基于精算数据，相对于历史对照，已推断出生存益处。目前已有足够多的患者获得足够的随访以了解切除CLM的治疗意向。方法对1985-1994年间接受CLM切除的患者进行了前瞻性数据库的回顾分析。不包括术后死亡病例。采用Kaplan-Meier方法计算肝切除术后的疾病特异性生存率(DSS)。结果612例患者获得10年随访。中位DSS为44个月。实际有102名10年的幸存者。102例中有99例(97%)在最后一次随访时无病。只有一名患者在存活10年后经历了特定疾病的死亡。相比之下，5年幸存者中34%的人死于癌症。在102名实际的10年幸存者中，先前发现的不良预后因素包括7%的同步疾病，36%的无病间隔不到12个月，25%的胆叶转移，50%的原发淋巴结阳性，39%的转移以上，35%的肿瘤大小超过5厘米。结论存活10年的患者似乎治愈了他们的疾病，而实际5年的幸存者中大约有三分之一死于癌症相关的死亡。在精心挑选的患者中，至少有六分之一的人有机会在肝切除后治愈CLM。预后不良因素的存在并不排除长期存活和治愈的可能性。
Purpose Resection of colorectal liver metastases (CLM) in selected patients has evolved as the standard of care during the last 20 years. In the absence of prospective randomized clinical trials, a survival benefit has been deduced relative to historical controls based on actuarial data. There is now sufficient follow-up on a significant number of patients to address the curative intent of resecting CLM.Methods Retrospective review of a prospectively maintained database was performed on patients who underwent resection of CLM from 1985 to 1994. Postoperative deaths were excluded. Disease-specific survival (DSS) was calculated from the time of hepatectomy using the Kaplan-Meier method.Results There were 612 consecutive patients identified with 10-year follow-up. Median DSS was 44 months. There were 102 actual 10-year survivors. Ninety-nine (97%) of the 102 were disease free at last follow-up. Only one patient experienced a disease-specific death after 10 years of survival. In contrast, 34% of the 5-year survivors suffered a cancer-related death. Previously identified poor prognostic factors found among the 102 actual 10-year survivors included 7% synchronous disease, 36% disease-free interval less than 12 months, 25% bilobar metastases, 50% node-positive primary, 39% more than one metastasis, and 35% tumor size more than 5 cm.Conclusion Patients who survive 10 years appear to be cured of their disease, whereas approximately one third of actual 5-year survivors succumb to a cancer-related death. In well-selected patients, there is at least a one in six chance of cure after hepatectomy for CLM. The presence of poor prognostic factors does not preclude the possibility of long-term survival and cure.