Association of Simultaneous vs Delayed Resection of Liver Metastasis With Complications and Survival Among Adults With Colorectal Cancer.
Association of Simultaneous vs Delayed Resection of Liver Metastasis With Complications and Survival Among Adults With Colorectal Cancer.
复制标题
同时与结直肠癌成年人的并发症和生存的同时延迟切除术与延迟切除。
DOI：
10.1001/jamanetworkopen.2022.31956
复制
发表时间：
2022-09-01
影响因子：
13.8
通讯作者：
Wang, Lu
中科院分区：
文献类型：
--
作者：
Wu, Yibin;Mao, Anrong;Wang, Huipeng;Fang, Guojiu;Zhou, Jiamin;He, Xigan;Cai, Sanjun;Wang, Lu
这项比较有效性研究检查了接受同步肝转移治疗的有或没有 KRAS 序列变异的患者的总体生存率和癌症特异性生存率。对于有或没有 KRAS 序列变异的成人结直肠癌患者，同时切除肝转移瘤和延迟切除肝转移瘤与主要并发症和生存率有何关系？在这项对 1569 名可切除同步肝转移患者进行的比较有效性研究中，对于 KRAS 野生型肿瘤患者，同时切除比延迟切除具有更长的生存率，但对于 KRAS 序列变异的患者则不然。这项研究的结果表明，在治疗选择中整合分子特征为准确、个体化的治疗提供了理论基础。同时或延迟切除同时性肝转移（SLM）与原发性结直肠癌（CRC）仍然是一个有争议的话题。旨在研究可切除 SLM 患者同时切除与延迟切除的结果。这项比较有效性研究纳入了2000年1月1日至2019年12月31日期间在中国3个独立中心接受根治性肝切除术的1569名可切除SLM患者。进行了1:1倾向评分匹配。随访于2021年8月31日完成，数据分析时间为2022年4月1日至30日。主要结果是术后60天内出现至少1种主要并发症的患者百分比。次要结局是术中和术后并发症、总生存率（OS）和癌症特异性生存率（CSS）。在纳入的 1569 名患者中，1057 名 (67.4%) 接受了延迟切除术（719 名男性 [68.0%]，平均 [SD] 年龄为 57.4 [11.2] 岁），512 名患者（310 名男性 [60.5%]，平均 [SD] 年龄为 57.1 [10.5] 岁）接受了同时切除。匹配后，495 对患者同时接受了切除术。同时切除组和延迟切除组之间主要围手术期并发症的百分比没有差异（34.1% vs 30.0%；P = .89）。延迟切除组的 OS 率为 3 年 65.2%、5 年 47.1% 和 8 年 38.0%，同时切除组 3 年 78.0%、5 年 65.4% 和 8 年 63.1%（风险比 [HR]，1.42；95% CI，1.10-1.85， P = .003)。延迟切除组的 CSS 率为 3 年时 68.3%、5 年时 48.5%、8 年时 37.1%，同时切除组 3 年时 CSS 率为 79.2%、5 年时 67.2%、8 年时 65.9%（HR，1.45；95% CI，1.14-1.98； P = .004)。根据 KRAS 序列变异状态比较两种策略的亚组分析显示，同时切除组的 OS 率（HR，1.61；95% CI，1.45-2.18；P < .001）和 CSS 率（HR，1.62；95 CI，1.40-1.87；P = .003]）均显着优于延迟切除组。 KRAS野生型肿瘤患者的切除组。这项研究的结果表明，同时切除 CRC 和 SLM 时，并发症发生率没有差异，并且同时切除的生存获益仅限于 KRAS 野生型肿瘤患者。将分子特征整合到治疗决策中是准确、个体化治疗的基础。
This comparative effectiveness research examines overall survival and cancer-specific survival in patients with or without KRAS sequence variation who received treatment for synchronous liver metastases. What is the association of simultaneous vs delayed resection of liver metastases with major complications and survival in adults with colorectal cancer with or without KRAS sequence variation? In this comparative effectiveness research study of 1569 patients with resectable synchronous liver metastases, simultaneous resection was associated with longer survival rates than delayed resection in patients with KRAS wild-type tumors but not in patients with KRAS sequence variation. Findings of this study suggest that integrating molecular features in the choice of treatment provides a theoretical basis for accurate, individualized treatments. Simultaneous or delayed resection of synchronous liver metastasis (SLM) with primary colorectal cancer (CRC) remains a controversial topic. To investigate the outcomes of simultaneous vs delayed resection in patients with resectable SLM. This comparative effectiveness research study included 1569 patients with resectable SLM who underwent curative-intent liver resection at 3 independent centers in China between January 1, 2000, to December 31, 2019. A 1:1 propensity score matching was performed. Follow-up was completed on August 31, 2021, and the data were analyzed from April 1 to 30, 2022. Primary outcome was the percentage of patients with at least 1 major complication within 60 days after surgery. Secondary outcomes were intraoperative and postoperative complications, overall survival (OS), and cancer-specific survival (CSS) rates. Among the 1569 patients included, 1057 (67.4%) underwent delayed resection (719 men [68.0%] with a mean [SD] age of 57.4 [11.2] years), and 512 patients (310 men [60.5%] with a mean [SD] age of 57.1 [10.5] years) underwent simultaneous resection. Matching yielded 495 pairs of patients underwent simultaneous resection. The percentage of major perioperative complications did not differ between the simultaneous and delayed resection groups (34.1% vs 30.0%; P = .89). The OS rates were 65.2% at 3 years, 47.1% at 5 years, and 38.0% at 8 years for the delayed resection group and 78.0% at 3 years, 65.4% at 5 years, and 63.1% at 8 years for the simultaneous resection group (hazard ratio [HR], 1.42; 95% CI, 1.10-1.85, P = .003). The CSS rates were 68.3% at 3 years, 48.5% at 5 years, and 37.1% at 8 years for the delayed resection group and 79.2% at 3 years, 67.2% at 5 years, and 65.9% at 8 years for the simultaneous resection group (HR, 1.45; 95% CI, 1.14-1.98; P = .004). On subgroup analysis comparing the 2 strategies according to the KRAS sequence variation status, the OS rates (HR, 1.61; 95% CI, 1.45-2.18; P < .001) and CSS rates (HR, 1.62; 95 CI, 1.40-1.87; P = .003]) in the simultaneous resection group were significantly better than those in the delayed resection group in patients with KRAS wild-type tumors. Results of this study suggest that complication rates did not differ when CRC and SLM were resected simultaneously and that the survival benefits of simultaneous resection were restricted to patients with KRAS wild-type tumors. Integrating molecular features into the treatment decision is a basis for accurate, individualized treatments.
登录
查看更多内容
影响因子：
9.6
作者：
de Haas, R. J.;Adam, R.;Castaing, D.
通讯作者：
Castaing, D.
影响因子：
6
作者：
László L;Kurilla A;Takács T;Kudlik G;Koprivanacz K;Buday L;Vas V
通讯作者：
Vas V
影响因子：
3.4
作者：
Vera, R.;Gonzalez-Flores, E.;Suarez-Artacho, G.
通讯作者：
Suarez-Artacho, G.
影响因子：
3.7
作者：
Feng Q;Wei Y;Zhu D;Ye L;Lin Q;Li W;Qin X;Lyu M;Xu J
通讯作者：
Xu J
影响因子：
8.8
作者：
Allard, M. A.;Adam, R.;Figueras, J.
通讯作者：
Figueras, J.