Not all early recurrences define futility: relapse patterns shape outcomes after colorectal liver metastases resection.

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-09-22 DOI:10.1016/j.hpb.2026.09.005

Rebecca Marino, Buonanno Silvia, Catena Marco, Remo Alessandris, Emanuele Mini, Federica Cipriani, Luca Ruotolo, Chiara Bonini, Francesca Ratti

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引用次数: 0

Abstract

Background: Recurrence after curative resection of colorectal liver metastases (CRLM) is heterogeneous. Early recurrence not always implies futile surgery. This study distinguishes predictors of early recurrence versus futile surgery and examines recurrence patterns.

Methods: This study analyzed the prospective LiMeT cohort of patients undergoing curative-intent resection for CRLM at IRCCS San Raffaele. Early recurrence was defined as <12 months and futile surgery as Time-to-Surgical-Failure (TSF) < 12 months (unresectable recurrence, progression, or death). Logistic regression identified predictors, and Sankey analysis mapped recurrence characteristics.

Results: Two hundred twenty-eight patients were included: 74 without recurrence, 115 early recurrences, and 39 late recurrences. Early recurrence was independently associated with synchronous CRLM (OR1.56, p = 0.02), primary tumor N1-N2 stage (OR2.23, p < 0.01), KRAS mutation (OR2.40, p = 0.024), ≥5 CRLM (OR2.15, p < 0.01), and metastatic diameter ≥3 cm (OR2.19, p < 0.01). Futility was associated with age>65, T4 stage, KRAS mutation, and no adjuvant chemotherapy. Sankey analysis showed that early recurrence not always leads to futility, often remaining liver-limited or oligometastatic.

Conclusion: Early recurrence and futile surgery represent distinct forms of postoperative failure. Early recurrence reflects tumor burden and biology, whereas futility identifies relapse that becomes unresectable or fatal, negating benefit. TSF provides complementary information on the durability of surgical benefit.

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并非所有的早期复发都是无效的：复发模式决定了结直肠癌肝转移切除后的预后。

背景：结直肠肝转移瘤（CRLM）根治性切除后的复发是不均匀的。早期复发并不一定意味着无效的手术。本研究区分了早期复发与无效手术的预测因素，并检查了复发模式。方法：本研究分析了在圣拉斐尔IRCCS接受治疗意图切除的CRLM患者的前瞻性LiMeT队列。结果：纳入228例患者：无复发74例，早期复发115例，晚期复发39例。早期复发与同步CRLM （OR1.56, p = 0.02）、原发肿瘤N1-N2期（OR2.23, p < 0.01）、KRAS突变（OR2.40, p = 0.024）、≥5 CRLM （OR2.15, p < 0.01）、转移直径≥3cm （OR2.19, p < 0.01）独立相关。不孕与年龄bb0 ~ 65岁、T4分期、KRAS突变和无辅助化疗有关。Sankey分析显示，早期复发并不总是导致无效，通常仍然存在肝限制或少转移。结论：早期复发和无效手术是不同形式的术后失败。早期复发反映了肿瘤负荷和生物学，而无效则表明复发变得不可切除或致命，对获益不利。TSF提供了关于手术疗效持久性的补充信息。

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

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).