Background:Colorectal liver metastases (CRLM) occur in up to 50% of colorectal cancer with a significant impact on patient survival, of whom only 20–30% will be considered suitable for surgical treatment. Despite the progress in systemic therapies, palliative chemotherapy alone results in a 5-year overall survival (OS) < 10%. Recently, liver transplantation (LT) has been reconsidered as an option and demonstrates improved survival in highly selected patients. This study assessed the impact of implementing a standardised patient selection protocol (LITORALE) on post-transplant outcomes for unresectable CRLM (uCRLM) at a high-volume single centre. Methods: This is a prospective observational study including all consecutive patients transplanted for uCRLM at our institution between July 2015 and September 2024. This prospective observational study evaluated the impact of the LITORALE protocol on post-transplant outcomes in uCRLM patients at a single centre. Patients who underwent LT between July 2015 and September 2024 were grouped into pre-LITORALE (2015–2021) and LITORALE (post-2021) cohorts. Recipient profiles, transplant variables, and post-transplant outcomes were compared.Results: Twenty-one patients were included (eight pre-LITORALE, thirteen LITORALE). The LITORALE group had a lower median number of lesions (4 vs. 17.5,p= 0.004), a smaller major lesion size (3 cm vs. 5.5 cm,p= 0.082), and a significantly lower tumour burden score (6.32 vs. 18.02,p= 0.002). Similar to recent major clinical trials, one- and three-years OS were 100% and 83%, respectively, after protocol introduction; recurrence patterns were significantly different, with reduced multi-site recurrences (7.7% vs. 50%,p= 0.048) and a higher incidence of lung-only recurrences in the LITORALE group (50% vs. 0%,p= 0.033).Conclusions: The introduction of the LITORALE protocol significantly influenced patient selection and recurrence patterns in LT for uCRLM. Although the limited number of patients and the short study timespan highlight the need for future validation, these preliminary results support the adoption of structured, multidisciplinary criteria to optimise oncologic outcomes.
背景：结直肠癌肝转移（CRLM）在结直肠癌患者中的发生率高达50%，对患者生存率有显著影响，其中仅20-30%的患者被认为适合手术治疗。尽管全身治疗取得进展，单纯姑息化疗的5年总生存率（OS）仍低于10%。近年来，肝移植（LT）被重新考虑为一种治疗选择，并在严格筛选的患者中显示出生存获益。本研究评估了在大型单中心对不可切除CRLM（uCRLM）患者实施标准化患者筛选方案（LITORALE）对移植后结局的影响。 方法：本研究为前瞻性观察性研究，纳入2015年7月至2024年9月期间在本机构因uCRLM接受肝移植的所有连续患者。该研究评估了LITORALE方案对单中心uCRLM患者移植后结局的影响。将2015年7月至2024年9月期间接受肝移植的患者分为LITORALE方案前（2015-2021年）和LITORALE方案后（2021年后）队列。比较了受者特征、移植相关变量及移植后结局。 结果：共纳入21例患者（LITORALE前组8例，LITORALE组13例）。LITORALE组患者的中位病灶数量较少（4个 vs. 17.5个，p=0.004），主要病灶尺寸较小（3 cm vs. 5.5 cm，p=0.082），肿瘤负荷评分显著更低（6.32 vs. 18.02，p=0.002）。与近期主要临床试验结果相似，方案引入后患者1年和3年总生存率分别为100%和83%；复发模式存在显著差异，LITORALE组多部位复发率降低（7.7% vs. 50%，p=0.048），且仅肺复发发生率更高（50% vs. 0%，p=0.033）。 结论：LITORALE方案的引入显著影响了uCRLM肝移植的患者筛选和复发模式。尽管患者数量有限且研究时间较短，凸显了未来验证的必要性，但这些初步结果支持采用结构化的多学科标准以优化肿瘤学结局。
肿瘤(癌症)患者之家