Background:Colorectal cancer (CRC) is a significant global health burden, with liver metastases representing a key prognostic factor. Neoadjuvant chemotherapy (NAC) has improved outcomes in metastatic CRC (mCRC), and tumor regression is commonly assessed using the Rubbia–Brandt classification. The Poultsides classification defines ≥40% fibrosis as an independent prognostic factor, particularly in patients treated with cetuximab (45.71%). However, the predictive value of this threshold remains under debate, warranting further investigation.Methods:This study evaluates the extent of fibrosis (≥40%) induced by NAC plus anti-epidermal growth factor receptor (anti-EGFR) therapy vs. NAC plus anti-vascular endothelial growth factor (anti-VEGF) therapy in mCRC patients. It also examines the prognostic relevance of the Poultsides and Rubbia–Brandt classifications. A total of 108 patients undergoing liver resection for CRC metastases were included. Statistical analyses were performed using SPSS 28.0 version and R software 4.5 version to compare fibrosis rates and survival outcomes.Results:From September 2005 to January 2023, 108 patients were analyzed: 54 received chemotherapy plus anti-EGFR (Cohort 1), and 54 received chemotherapy plus anti-VEGF (Cohort 2). Fibrosis was significantly higher in Cohort 1 (median 40.0%, IQR: 25.4–53.2) than in Cohort 2 (median 20.6%, IQR: 8.07–36.9),p< 0.001. Overall survival was similar between both cohorts (p= 0.96), with a median follow-up of 41.6 months.Conclusions:Anti-EGFR therapy is associated with greater fibrosis than anti-VEGF, despite similar survival outcomes. The Poultsides classification may be a useful prognostic tool for resected liver metastases in mCRC.
背景：结直肠癌（CRC）是全球重大健康负担，肝转移是其关键预后因素。新辅助化疗（NAC）改善了转移性结直肠癌（mCRC）的治疗效果，肿瘤退缩通常采用Rubbia–Brandt分级进行评估。Poultsides分级将≥40%的纤维化定义为独立预后因素，特别是在接受西妥昔单抗治疗的患者中（45.71%）。然而，该阈值的预测价值仍存争议，需要进一步研究。 方法：本研究评估了mCRC患者接受NAC联合抗表皮生长因子受体（抗-EGFR）治疗与NAC联合抗血管内皮生长因子（抗-VEGF）治疗所诱导的纤维化程度（≥40%），并检验了Poultsides分级和Rubbia–Brandt分级的预后相关性。共纳入108例因CRC肝转移接受肝切除术的患者。使用SPSS 28.0版和R软件4.5版进行统计分析，比较纤维化率和生存结局。 结果：2005年9月至2023年1月期间，共分析108例患者：54例接受化疗联合抗-EGFR治疗（队列1），54例接受化疗联合抗-VEGF治疗（队列2）。队列1的纤维化程度显著高于队列2（中位数40.0%，IQR：25.4–53.2 vs. 中位数20.6%，IQR：8.07–36.9），p < 0.001。两组总生存期相似（p = 0.96），中位随访时间为41.6个月。 结论：尽管生存结局相似，但抗-EGFR治疗相较于抗-VEGF治疗与更高的纤维化程度相关。Poultsides分级可能成为mCRC肝转移切除术后的有效预后评估工具。
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