New definition of borderline resectable colorectal liver metastasis based on prognostic outcomes.

IF 2.1 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2024-10-08 DOI:10.1007/s00423-024-03492-9

Naokazu Chiba, Shoma Iida, Masashi Nakagawa, Takahiro Gunji, Kei Yokozuka, Toshimichi Kobayashi, Toru Sano, Masatoshi Shigoka, Satoshi Tabuchi, Eiji Hidaka, Shigeyuki Kawachi

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引用次数: 0

Abstract

Background: Although surgical resection is the curative treatment for colorectal liver metastases (CRLM), the efficacy of neoadjuvant chemotherapy (NAC) has been discussed due to recent remarkable advances in chemotherapy. The definition of borderline resectable (BR) is most important, where neoadjuvant chemotherapy should be administered. This study aimed to examine a new definition of BR CRLM based on the results of the treatment outcomes.

Methods: This study included 127 patients who underwent liver resection for CRLM after exclusion of conversion cases between April 2010 and December 2023. Upfront resection was performed for synchronous and single liver metastasis or metachronous liver metastases. NAC was administered for multiple synchronous liver metastases. In order to find a new definition of BR, we examined the prognostic factors obtained from the treatment outcomes.

Results: CA19-9 level > 37.0 was the only prognostic factor in the upfront group [hazard ratio (HR) 2.386, 95% CI, 1.583-4.769; p = 0.049]. in the NAC group, a maximum tumor diameter ˃3 cm (HR 2.248, 95% CI 1.038-4,867, p = 0.040), CA19-9 level > 37.0 (HR 2.239, 95% CI 1.044-4.800, p = 0.038), and a right-sided primary tumor in the colon (HR 2.770, 95% CI 1.284-5.988, p = 0.009) were identified as significant prognostic factors.

Conclusions: In cases of CRLM, patients with CA19-9 levels > 37.0, or CA19-9 level with < 37.0 but with a primary tumor in the right colon or a maximum tumor diameter of > 3 cm can be defined as BR CRLM and should be treated with NAC.

查看原文本刊更多论文

基于预后结果的边缘可切除结直肠肝转移新定义。

背景：虽然手术切除是结直肠肝转移瘤（CRLM）的根治性治疗方法，但由于近年来化疗取得了显著进展，新辅助化疗（NAC）的疗效也一直备受讨论。边界可切除（BR）的定义最为重要，在此定义下应进行新辅助化疗。本研究旨在根据治疗结果对边界可切除CRLM进行新的定义：本研究纳入了2010年4月至2023年12月期间因CRLM接受肝脏切除术的127例患者，并排除了转化病例。对同步和单发肝转移瘤或转移性肝转移瘤进行前期切除。对于多发性同步肝转移灶，则采用NAC治疗。为了找到BR的新定义，我们研究了从治疗结果中得出的预后因素：CA19-9水平>37.0是前期组唯一的预后因素[危险比（HR）2.386，95% CI，1.583-4.769；P = 0.049]。在NAC组，肿瘤最大直径˃3厘米（HR 2.248，95% CI 1.038-4,867，P = 0.040）、CA19-9 水平 > 37.0（HR 2.239，95% CI 1.044-4.800，p = 0.038）和结肠右侧原发肿瘤（HR 2.770，95% CI 1.284-5.988，p = 0.009）被认为是显著的预后因素：结论：在CRLM病例中，CA19-9水平> 37.0或CA19-9水平达到3 cm的患者可定义为BR CRLM，应接受NAC治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.