Introduction: Colorectal cancer liver metastasis (CRCLM) remains a lethal diagnosis, with an overall 5-year survival rate of 5–10%. Two distinct histopathological growth patterns (HGPs) of CRCLM are known to have significantly differing rates of patient survival and response to treatment. We set out to review the results of 275 patients who underwent liver resection for CRCLM at the McGill University Health Center (MUHC) and analyze their clinical outcome, mutational burden, and pattern of cancer progression in light of their HGPs, and to consider their potential effect on surgical decision making. Methods: We performed a retrospective multivariate analysis on clinical data from patients with CRCLM (n= 275) who underwent liver resection at the McGill University Health Center (MUHC). All tumors were scored using international consensus guidelines by pathologists trained in HGP scoring. Results: A total of 109 patients (42.2%) were classified as desmoplastic and angiogenic, whereas 149 patients (57.7%) were non-desmoplastic and vessel co-opting. The 5-year survival rates for angiogenic patients compared with vessel co-opting patients were 47.1% and 13%, respectively (p< 0.0001). Multivariate analysis showed patients with vessel co-opting CRCLM had a higher incidence of extrahepatic metastatic disease (p= 0.0215) compared with angiogenic CRCLM. Additionally, KRAS mutation status was a marker of increased likelihood of disease recurrence (p= 0.0434), as was increased number of liver tumors (p= 0.0071) and multiple sites of extrahepatic metastatic disease (p< 0.0001). Conclusions: Multivariate analysis identified key clinical prognostic and molecular features correlating with the two HGPs. Determining liver tumor HGPs is essential for patient prognostication and treatment optimization.
引言：结直肠癌肝转移（CRCLM）仍是一种致命性诊断，其总体5年生存率为5-10%。已知CRCLM的两种不同组织病理学生长模式（HGPs）在患者生存率和治疗反应方面存在显著差异。本研究旨在回顾麦吉尔大学健康中心（MUHC）接受肝切除术的275例CRCLM患者的临床结果，结合其HGPs分析其临床结局、突变负荷及癌症进展模式，并探讨其对手术决策的潜在影响。方法：我们对麦吉尔大学健康中心接受肝切除术的CRCLM患者（n=275）的临床数据进行回顾性多变量分析。所有肿瘤均由经过HGP评分培训的病理学家依据国际共识指南进行评分。结果：109例患者（42.2%）被归类为促纤维增生性血管生成型，149例患者（57.7%）为非促纤维增生性血管共择型。血管生成型与血管共择型患者的5年生存率分别为47.1%和13%（p<0.0001）。多变量分析显示，与血管生成型CRCLM相比，血管共择型CRCLM患者肝外转移发生率更高（p=0.0215）。此外，KRAS突变状态是疾病复发可能性增加的标志（p=0.0434），肝内肿瘤数量增多（p=0.0071）和多部位肝外转移（p<0.0001）同样提示复发风险增高。结论：多变量分析确定了与两种HGPs相关的关键临床预后及分子特征。明确肝脏肿瘤的HGPs对患者预后评估和治疗优化至关重要。
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