肝脏R1切缘对结直肠癌肝转移肝内复发的影响

Effect of hepatic R1 margin on intrahepatic recurrence of colorectal cancer liver metastases

目的:为结直肠癌肝转移(CRLM)患者肝内切缘复发构建预测模型,了解R1切缘对肝内切缘复发是否存在影响。方法:回顾性分析2009年1月至2020年12月在北京大学第三医院普通外科接受手术治疗的123例CRLM患者资料,通过二元Logistic回归分析确立对影响肝内切缘复发有独立预测价值的因素,建立预测模型。结果:整个队列肝内切缘复发48例(39.0%),非切缘肝内复发75例(61.0%)。R0切除73例(59.3%),R1切除50例(40.7%)。单因素Logistic回归分析中转移灶最大直径(OR=2.396,P=0.041)、非解剖切除(OR=3.732,P=0.025)、手术时长(OR=2.571,P=0.013)、肝脏R1切缘(OR=2.907,P=0.005)与肝内切缘复发显著相关。多因素Logistic回归分析后R1切缘不再具有统计意义(OR=2.103,95%CI为0.94~4.65,P=4.70),而转移灶最大直径>21mm(OR=2.509,95%CI为1.02~6.17,P=0.045)、非解剖切除(OR=3.585,95%CI为1.06~12.15,P=0.040)对肝内切缘复发有独立预测价值。结论:本研究建立的模型中R1切缘似乎有增加肝内切缘复发的风险,但未达到统计学意义。影响肝内切缘复发的独立危险因素为肝脏转移灶最大直径和非解剖切除。

Objective:The effect of R1 margin on liver resection for colorectal cancer liver metastasis(CRLM)has been controversial,and there is a lack of models for the effect of hepatic R1 margin on intrahepatic margin recurrence.This study aimed to construct a predictive model for intrahepatic margin recurrence in CRLM patients to understand whether there is an effect of R1 margin on intrahepatic margin recurrence.Methods:The data of 123 CRLM patients undergoing surgical treatment in the General Surgery Department of Peking University Third Hospital from January 2009 to December 2020 were retrospectively analyzed,and the factors with independent predictive value for intrahepatic margin recurrence were established through binary Logistic regression analysis,and the predictive model was established.Results:The whole cohort had 48(39.0%)and 75(61.0%)non-hepatic recurrence.73(59.3%)of R0 resection and 50(40.7%)of R1 resection.In the univariate regression analysis,the maximum diameter of metastases(OR=2.396,P=0.041),non-anatomical resection(OR=3.732,P=0.025),operation duration(OR=2.571,P=0.013),liver R1 margin(OR=2.907,P=0.005)were significantly associated with hepatic R.margin recurrence.After multivariate regression analysis,R1 margin was no longer statistically significant(OR=2.103,95%CI:0.94-4.65,P=4.70),while metastasis with maximum diameter>21 mm(OR=2.509,95%CI:1.02-6.17,P=0.045)and non-anatomical resection(OR=3.585,95%CI:1.06-12.15,P=0.040)had independent predictive value for intrahepatic margin recurrence.Conclusions:The R1 margin in the model established in this study seemed to increase the risk of intrahepatic margin recurrence,but did not reach statistical significance.Independent risk factors affecting intrahepatic margin recurrence were the maximum diameter of hepatic metastases and non-anatomical resection.