Hepatectomy and/or local ablation therapy have been recommended for colorectal cancer liver metastases (CRLM). However, they still lack strong evidence for their survival benefits, in addition to systemic therapy. This study aims to evaluate the survival evidence of hepatectomy and/or radiofrequency ablation (RFA) therapy in CRLM patients from a large multi-institutional database. A total of 20,251 patients with colorectal cancer, 4521 of whom were with CRLM, were screened for eligibility. Finally, 2612 patients (637 hepatectomy, 93 RFA, 92 combined hepatectomy and RFA, and 1790 non-aggressive treatment) were enrolled. Frequency matching analysis was used to adjust for baseline differences. The 5-year overall survival (OS) was as follows: hepatectomy alone was 47.8%, combined hepatectomy plus RFA was 35.9%, RFA alone was 29.2%, and the non-aggressive treatment group was 7.4%. Kaplan–Meier curves showed that hepatectomy, RFA, and combination were significantly associated with a better OS compared to those without aggressive local therapy (p< 0.001). Multivariate Cox regression analysis showed that male gender (hazard ratio (HR) 0.89; 95% confidence interval (CI), 0.81–0.97;p= 0.011), old age (≥60 years) (HR 1.20; 95% CI, 1.09–1.32;p< 0.001), high CEA level (>5 ng/mL) (HR 2.14; 95% CI, 1.89–2.42;p< 0.001), primary right-sided cancer (HR 1.35; 95% CI, 1.22–1.51;p< 0.001), extrahepatic metastasis (HR 1.46; 95% CI, 1.33–1.60;p< 0.001), systemic therapy (HR 0.7; 95% CI, 0.62–0.79;p< 0.001), and aggressive local therapy (hepatectomy vs. non-local therapy HR 0.22; 95% CI, 0.20–0.26;p< 0.001; RFA vs. non-local therapy HR 0.29; 95% CI, 0.29–0.41;p< 0.001) were independent factors associated with OS. In the frequency matching analysis, patients receiving hepatectomy and/or RFA resulted in a better OS than those without (p< 0.001). In conclusion, aggressive local treatment provides survival advantages over systemic therapy alone among CRLM patients.
肝切除术和/或局部消融治疗已被推荐用于结直肠癌肝转移（CRLM）的治疗。然而，除了全身治疗外，这些局部治疗手段的生存获益仍缺乏强有力的证据支持。本研究旨在通过大型多机构数据库，评估肝切除术和/或射频消融（RFA）治疗对CRLM患者的生存获益证据。研究共筛选了20,251例结直肠癌患者，其中4521例为CRLM患者。最终，2612例患者（637例接受肝切除术，93例接受RFA，92例接受肝切除术联合RFA，1790例接受非积极局部治疗）被纳入分析。采用频数匹配分析以调整基线差异。各组5年总生存率（OS）如下：单纯肝切除术组为47.8%，肝切除术联合RFA组为35.9%，单纯RFA组为29.2%，非积极局部治疗组为7.4%。Kaplan-Meier曲线显示，与未接受积极局部治疗的患者相比，接受肝切除术、RFA或联合治疗的患者OS显著更优（p < 0.001）。多变量Cox回归分析表明，男性（风险比（HR）0.89；95%置信区间（CI），0.81–0.97；p = 0.011）、高龄（≥60岁）（HR 1.20；95% CI，1.09–1.32；p < 0.001）、高CEA水平（>5 ng/mL）（HR 2.14；95% CI，1.89–2.42；p < 0.001）、原发右侧结肠癌（HR 1.35；95% CI，1.22–1.51；p < 0.001）、肝外转移（HR 1.46；95% CI，1.33–1.60；p < 0.001）、全身治疗（HR 0.7；95% CI，0.62–0.79；p < 0.001）以及积极局部治疗（肝切除术 vs. 无局部治疗 HR 0.22；95% CI，0.20–0.26；p < 0.001；RFA vs. 无局部治疗 HR 0.29；95% CI，0.29–0.41；p < 0.001）是OS的独立影响因素。在频数匹配分析中，接受肝切除术和/或RFA治疗的患者OS优于未接受者（p < 0.001）。总之，对于CRLM患者，积极的局部治疗相较于单纯全身治疗能提供生存优势。
肿瘤(癌症)患者之家