One-Millimeter Cancer-Free Margin Is Curative for Colorectal Liver Metastases A Propensity Score Case-Match Approach
One-Millimeter Cancer-Free Margin Is Curative for Colorectal Liver Metastases A Propensity Score Case-Match Approach
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DOI：
10.1097/sla.0b013e3182902b6e
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发表时间：
2014-03-01
影响因子：
9
通讯作者：
Rees, Myrddin
中科院分区：
文献类型：
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作者：
Hamady, Zaed Z. R.;Lodge, J. Peter A.;Rees, Myrddin
目的：探讨明确手术切除切缘宽度对结肠肝转移性病灶有意治愈性切除后疾病复发率的影响。背景：组织学阳性切除切缘是结直肠肝转移瘤切除后疾病复发的预测因子，这是共识。然而，关于所需的无癌切除边缘宽度的争论仍在继续。方法：对来自英国2个主要肝胆单位的2715例结肠直肠肝转移患者的观察性前瞻性数据进行分析。组织学无癌切除切缘分为阳性（如果癌细胞出现在距离切除切缘小于1mm的地方）或阴性（如果肿瘤与切缘之间的距离大于等于1mm）。阴性切缘根据与肿瘤的距离进一步分类，以毫米为单位。对无病生存的预测因素进行单因素和多因素分析。采用倾向评分法进行病例匹配分析以减少偏倚。结果：1毫米的无癌切除切缘足以达到33%的5年总无病生存率。额外的切缘宽度没有增加无病生存优势（P < 0.05）。经倾向病例匹配分析，阴性窄切缘廓清和阴性宽切缘廓清患者的无病生存率无统计学差异[危险比（HR） 1.0；95%（置信区间）CI: 0.9-1.2；5 mm截止时P = 0.579， HR为1.1；95% ci: 0.96-1.3；P = 0.149 （10-mm截止）。肝外疾病和淋巴结原发性肿瘤阳性的患者，尽管手术边缘清除（9个月），但没有无病生存优势
Objective: To investigate the influence of clear surgical resection margin width on disease recurrence rate after intentionally curative resection of colorectal liver metastases.Background: There is consensus that a histological positive resection margin is a predictor of disease recurrence after resection of colorectal liver metastases. The dispute, however, over the width of cancer-free resection margin required is ongoing.Methods: Analysis of observational prospectively collected data for 2715 patients who underwent primary resection of colorectal liver metastases from 2 major hepatobiliary units in the United Kingdom. Histological cancer-free resection margin was classified as positive (if cancer cells present at less than 1 mm from the resection margin) or negative (if the distance between the cancer and the margin is 1 mm or more). The negative margin was further classified according to the distance from the tumor in millimeters. Predictors of disease-free survival were analyzed in univariate and multivariate analyses. A case-match analysis by a propensity score method was undertaken to reduce bias.Results: A 1-mm cancer-free resection margin was sufficient to achieve 33% 5-year overall disease-free survival. Extra margin width did not add disease-free survival advantage (P > 0.05). After the propensity case-match analysis, there is no statistical difference in disease-free survival between patients with negative narrow and wider margin clearance [hazard ratio (HR) 1.0; 95% (confidence interval) CI: 0.9-1.2; P = 0.579 at 5-mm cutoff and HR 1.1; 95% CI: 0.96-1.3; P = 0.149 at 10-mm cutoff]. Patients with extrahepatic disease and positive lymph node primary tumor did not have disease-free survival advantage despite surgical margin clearance (9 months for