文章：

肝外疾病存在时结直肠肝转移的局部治疗：来自阿姆斯特丹结直肠肝转移登记处（AmCORE）的生存结果分析

Local Treatment of Colorectal Liver Metastases in the Presence of Extrahepatic Disease: Survival Outcomes from the Amsterdam Colorectal Liver Met Registry (AmCORE)

原文发布日期：8 March 2024

DOI: 10.3390/cancers16061098

类型: Article

开放获取: 是

英文摘要：

Background: The simultaneous presence of colorectal liver metastases (CRLMs) and extrahepatic metastases in patients with colorectal cancer (CRC) can be considered a relative contraindication for local treatment with curative intent. This study aims to assess the survival outcomes of patients with CRLMs and extrahepatic metastases after comprehensive local treatment of all metastatic sites. Methods: Patients with CRLMs who received local treatment of all metastatic sites were extracted from the prospective AmCORE registry database and subdivided into two groups: CRLM only vs. CRLM and extrahepatic metastasis. To address potential confounders, multivariate analysis was performed. The primary endpoint was overall survival (OS). Results: In total, 881 patients with CRLM only and 60 with CRLM and extrahepatic disease were included, and the median OS was 55.7 months vs. 42.7 months, respectively. Though OS was significantly lower in patients with concomitant extrahepatic metastases (HR 1.477; 95% CI 1.029–2.121;p= 0.033), the survival curve plateaued after 6.2 years. Extrahepatic manifestations were pulmonary (43.3%), peritoneal (16.7%) and non-regional lymph node metastases (10.0%). In patients with pulmonary and non-regional lymph node metastases, OS did not significantly differ from patients with CRLM-only disease; concomitant peritoneal metastases showed an inferior OS (HR 1.976; 95% CI 1.017–3.841,p= 0.041). Conclusions: In this comparative series, OS was inferior for patients with multi-organ metastatic CRC versus patients with CRLMs alone. Nonetheless, the long-term survival curve plateau seemed to justify local treatment in a subset of patients with multi-organ metastatic CRC, especially for patients with CRLMs and pulmonary or lymph node metastases.

摘要翻译： 

背景：结直肠癌（CRC）患者同时存在结直肠肝转移（CRLM）和肝外转移，通常被视为根治性局部治疗的相对禁忌症。本研究旨在评估所有转移灶接受全面局部治疗后，CRLM合并肝外转移患者的生存结局。方法：从前瞻性AmCORE登记数据库中筛选出所有转移灶均接受局部治疗的CRLM患者，并将其分为两组：单纯CRLM组与CRLM合并肝外转移组。为控制潜在混杂因素，研究进行了多变量分析。主要终点为总生存期（OS）。结果：共纳入881例单纯CRLM患者和60例CRLM合并肝外转移患者，中位OS分别为55.7个月和42.7个月。尽管合并肝外转移患者的OS显著降低（HR 1.477；95% CI 1.029–2.121；p=0.033），但生存曲线在6.2年后进入平台期。肝外转移部位包括肺转移（43.3%）、腹膜转移（16.7%）和非区域淋巴结转移（10.0%）。肺转移和非区域淋巴结转移患者的OS与单纯CRLM患者无显著差异；而合并腹膜转移患者的OS较差（HR 1.976；95% CI 1.017–3.841，p=0.041）。结论：在本比较性研究中，多器官转移性CRC患者的总生存期低于单纯CRLM患者。然而，长期生存曲线平台期的出现表明，对部分多器官转移性CRC患者（尤其是合并肺转移或淋巴结转移的CRLM患者）进行局部治疗具有临床合理性。

原文链接：

Local Treatment of Colorectal Liver Metastases in the Presence of Extrahepatic Disease: Survival Outcomes from the Amsterdam Colorectal Liver Met Registry (AmCORE)