Background: The purpose of this study was to determine the optimal definition and elucidate the predictive factors of early recurrence after surgery for colorectal liver metastases (CRLM).
Methods: Among 987 patients who underwent curative surgery for CRLM from 1990 to 2012, 846 with a minimum follow-up period of 24 months were eligible for this study. The minimum p value approach of survival after initial recurrence was used to determine the optimal cutoff for the definition of early recurrence. The predictive factors of early recurrence and prognostic factors of survival were analyzed.
Results: For 667 patients (79%) who developed recurrence, the optimal cutoff point of early recurrence was determined to be 8 months after surgery. The impact of early recurrence on survival was demonstrated mainly in patients who received preoperative chemotherapy. Among the 691 patients who received preoperative chemotherapy, recurrence was observed in 562 (81%), and survival in patients with early recurrence was significantly worse than in those with late recurrence (5-year survival 18.5% vs. 53.4%, p < .0001). Multivariate logistic analysis identified age ≤57 years (p = .0022), >1 chemotherapy line (p = .03), disease progression during last-line chemotherapy (p = .024), >3 tumors (p = .0014), and carbohydrate antigen 19-9 >60 U/mL (p = .0003) as independent predictors of early recurrence. Salvage surgery for recurrence significantly improved survival, even in patients with early recurrence.
Conclusion: The optimal cutoff point of early recurrence was determined to be 8 months. The preoperative prediction of early recurrence is possible and crucial for designing effective perioperative chemotherapy regimens.
Implications for practice: In this study, the optimal cutoff point of early recurrence was determined to be 8 months after surgery based on the minimum p value approach, and its prognostic impact was demonstrated mainly in patients who received preoperative chemotherapy. Five factors, including age, number of preoperative chemotherapy lines, response to last-line chemotherapy, number of tumors, and carbohydrate antigen 19-9 concentrations, were identified as predictors of early recurrence. Salvage surgery for recurrence significantly improved survival, even in patients with early recurrence. For better selection of patients who could truly benefit from surgery and should also receive strong postoperative chemotherapy, the accurate preoperative prediction of early recurrence is crucial.
摘要
背景. 本研究旨在确定结直肠癌肝转移 (CRLM) 手术后早期复发的最佳定义, 并探讨其预测因素。
方法. 1990-2012年间因CRLM接受根治术的987例患者中, 其中846例至少接受了24个月随访的患者符合本研究的入选要求。使用最小P值法对首次复发后的生存进行分析, 确定定义早期复发的最佳界值。研究还对早期复发的预测因素和生存的预后因素进行了分析。
结果. 对667例 (79%) 复发患者进行了分析, 确定早期复发的最佳界值为术后8个月。本研究主要在接受术前化疗的患者中证实了早期复发对生存的影响。在691例接受术前化疗的患者中, 观察到562例 (81%) 复发, 早期复发的患者生存率显著低于晚期复发者 (5年生存率18.5% vs. 53.4%, P<0.000 1)。多因素logistic分析发现, 年龄≤ 57岁 (P=0.002 2)、接受二线及以上化疗 (P=0.03)、在最近一线化疗治疗中发生疾病进展 (P=0.024)、肿瘤病灶> 3个 (P=0.001 4) 以及糖链抗原19-9水平> 60 U/L (P=0.000 3) 均为早期复发的独立预测因素。复发后行挽救性手术可显著改善生存, 即便在早期复发患者中也是如此。
结论. 早期复发的最佳界值为8个月。术前对早期复发进行预测是可能做到的, 并且对设计有效的围手术期化疗方案非常关键。The Oncologist 2016;21:887–894
对临床实践的提示: 本研究依据最小P值法确定早期复发的最佳界值为术后8个月, 其对预后的影响主要在术前接受化疗的患者中证实。我们发现包括年龄、术前化疗线数、对最近一次化疗线的治疗反应、肿瘤病灶数以及糖链抗原19-9水平在内的5个因素是早期复发的预测因素。对于复发患者, 施行挽救性手术可以显著改善生存, 即使对早期复发患者也是如此。为了更好地选择出能够从手术治疗中切实获益以及应该接受更强的术后化疗的患者, 准确地对早期复发进行术前预测是至关重要的。
Keywords: Colorectal liver metastasis; Early recurrence; Hepatectomy; Minimum p value approach; Salvage surgery.
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