结直肠癌伴同时性不可切除肝转移转化治疗的疗效分析

Conversion managment of colorectal cancer with simultaneous unresectable hepatic metastasis

目的:探讨不同转化治疗方案对结直肠癌伴不可切除的同时性肝转移患者的疗效。方法:本研究共纳入2015年1月—2020年12月南昌大学第一附属医院收治的结直肠癌伴肝转移170例患者,分为初始可切除组(42例)和初始不可切除组(128例)。结果:初始可切除的结直肠癌伴肝转移患者与通过转化治疗成功转化的患者在总生存期(OS)和无进展生存期(PFS)方面差异均无统计学意义(均P>0.05)。转化成功组的中位OS为36个月,而单纯原发肿瘤切除、未切除肝转移灶组为21个月,差异有统计学意义[HR=0.48(0.27~0.86),P=0.014];转化成功组的中位PFS为28个月,而单纯原发肿瘤切除、未切除肝转移灶组为10个月,差异有统计学意义[HR=0.43(0.24~0.77),P=0.005]。单纯原发肿瘤切除、未切除肝转移灶组与原发肿瘤和肝转移灶均未切除组的OS差异有统计学意义[21个月比13个月,HR=0.52(0.32~0.86),P=0.01];两组的PFS比较差异无统计学意义(P>0.05)。结论:转化治疗方案以化疗+靶向治疗方案效果最佳,能提高患者的R 0手术切除率和生存率;仅原发灶切除也能延长患者的生存期。

Objective To investigate the efficacy of different conversion therapies for colorectal cancer with unresectable simultaneous liver metastasis.Methods A total of 170 patients of colorectal cancer complicated with liver metastasis who were admitted to the First Affiliated Hospital of Nanchang University from Jan 2015 to Dec 2020 were included in the study.Patients were divided into an initial resectable group(42 cases)and an initial non-resectable group(128 cases).Results There were no significant differences in OS and PFS between patients with CRLM(colorectal cancer with liver metastasis)who were resected initially and those successfully underwent transformation therapy(P>0.05).The median OS was 36 months in the group with successful transformation,while it was 21 months in the group with simple primary tumor resection and no liver metastasis resection(P=0.014),HR=0.48(0.27-0.86).The median PFS was 28 months in the successful conversion group,while it was 10 months in the primary tumor resection only and no liver metastasis resection(P=0.005),HR=0.43(0.24-0.77).The 0S difference between the group with simple primary tumor resection and no resected liver metastasis and the group with neither primary tumor nor liver metastasis resection was statistically significant:(21 months vs.13 months),HR=0.52(0.32-0.86)(P=0.01),while the PFS between the two groups was not statistically significant,(P>0.05).Conclusions Chemotherapy combined with targeted therapy has the best effect among the conversion therapies,and can improve the resection rate and survival rate of patients undergoing Ro surgery.Resection of the primary lesion alone can also prolong the patient's survival.