Background/Objectives: There is still no consensus as to whether patients with upfront resectable synchronous colorectal liver metastases (sCRLM) should receive neoadjuvant treatment prior to liver surgery. Two randomized controlled trials have assessed the role of peri-operative chemotherapy in sCRLM; neither have shown a survival benefit in the neoadjuvant group. The aim of this population-based study was to examine overall survival in patients treated with neoadjuvant chemotherapy and hepatectomy compared to patients who had upfront surgery. Methods: This is a retrospective observational study between 2009 and 2017 containing data extracted from two Swedish national registries. Descriptive statistics and Cox regression analyses were employed. Results: In total, 2072 patients with sCRLM were treated with liver surgery between 2009 and 2017. A majority (n = 1238, 60%) were treated with neoadjuvant chemotherapy, and 834 patients (40%) had upfront surgery. Patients in the upfront surgery group were older (median age 70 compared to 65 years,p≤ 0.001). Median overall survival in the upfront surgery group was 26 months (95% CI 23–29 months) compared to 57 months (95% CI 42–48 months) in the neoadjuvant group, log rankp≤ 0.001. In the multivariable Cox regression analysis, age ≥ 70 years (HR 1.46, 95% CI 1.25–1.70), T category of primary cancer (HR 1.41, 95% CI 1.09–1.84), lymphatic spread of primary cancer (HR 1.68, 95% CI 1.41–1.99), and number of liver metastases (six or more metastases resulted in HR 2.05, 95% CI 1.38–3.01) negatively influenced overall survival. By contrast, adjuvant therapy was protective (HR 0.80, 95% CI 0–69–0.94), whereas neoadjuvant treatment compared to upfront surgery did not influence overall survival (HR 1.04, 95% CI 0.86–1.26). Conclusions: Neoadjuvant treatment in sCRLM did not confer a survival benefit compared to upfront surgery.
背景/目的：对于初始可切除的同步性结直肠癌肝转移（sCRLM）患者是否应在肝脏手术前接受新辅助治疗，目前仍无共识。两项随机对照试验评估了围手术期化疗在sCRLM中的作用，但均未显示新辅助治疗组存在生存获益。本项基于人群的研究旨在比较接受新辅助化疗联合肝切除术的患者与直接手术患者的总体生存情况。方法：本研究为2009年至2017年间的回顾性观察研究，数据来源于瑞典两个国家登记系统。采用描述性统计和Cox回归分析。结果：2009年至2017年间共有2072例sCRLM患者接受肝脏手术治疗。其中大多数患者（n=1238，60%）接受了新辅助化疗，834例患者（40%）接受直接手术。直接手术组患者年龄更大（中位年龄70岁对比65岁，p≤0.001）。直接手术组中位总生存期为26个月（95% CI 23-29个月），而新辅助治疗组为57个月（95% CI 42-48个月），时序检验p≤0.001。在多变量Cox回归分析中，年龄≥70岁（HR 1.46，95% CI 1.25-1.70）、原发癌T分期（HR 1.41，95% CI 1.09-1.84）、原发癌淋巴转移（HR 1.68，95% CI 1.41-1.99）以及肝转移灶数量（6个及以上转移灶HR 2.05，95% CI 1.38-3.01）对总生存期产生负面影响。相比之下，辅助治疗具有保护作用（HR 0.80，95% CI 0.69-0.94），而新辅助治疗与直接手术相比并未影响总生存期（HR 1.04，95% CI 0.86-1.26）。结论：与直接手术相比，sCRLM患者接受新辅助治疗并未带来生存获益。
肿瘤(癌症)患者之家