初始不可切除结直肠癌肝转移转化治疗结局影响因素分析  

Prognostic factors affecting the success of conversion chemotherapy in patients with unresectable liver metastases from initially colorectal cancer

作　　者：张炜力 周驰 邓宇翔 侯振林 张林杰[1] 林俊忠[1] 潘志忠[1] 卢震海[1] 彭健宏[1] Zhang Weili;Zhou Chi;Deng Yuxiang;Hou Zhenlin;Zhang Linjie;Lin Junzhong;Pan Zhizhong;Lu Zhenhai;Peng Jianhong(Department of Colorectal Surgery,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心结直肠科华南肿瘤学国家重点实验室肿瘤医学协同创新中心,广州510060

出　　处：《中华胃肠外科杂志》2022年第1期56-62,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金青年项目(82003051)。

摘　　要：目的研究初始不可切除结直肠癌肝转移(CRLM)转化治疗结局影响因素,为制定患者的个体化治疗策略提供循证医学证据。方法本研究采用回顾性病例对照研究方法,纳入中山大学肿瘤防治中心2013年1月至2020年1月期间新初始不可切除、经过一线全身治疗且转化成功的98例CRLM患者,并将同期入院、但转化失败的134例CRLM患者纳为对照组。转化治疗方案:38例接受FOLFOXIRI方案化疗(伊立替康、奥沙利铂、亚叶酸钙和氟尿嘧啶),152例接受FOLFOX方案化疗(奥沙利铂、亚叶酸钙和氟尿嘧啶),19例接受FOLRIRI方案化疗(伊立替康、亚叶酸钙和氟尿嘧啶),23例接受全身化疗联合氟尿苷肝动脉灌注化疗;168例接受了靶向治疗,其中68例贝伐单抗,100例西妥昔单抗。采用Logistic回归分析临床因素对转化治疗结局的影响。结果232例纳入分析的患者中,98例转化成功,转化成功率42.2%,其中30例接受单纯肝切除,68例接受肝切除联术中射频消融。一线化疗后获得部分缓解111例(47.8%),疾病稳定57例(24.6%),疾病进展64例(27.6%)。中位随访18.8(1.0~87.9)个月,148例患者肿瘤进展或死亡,转化成功患者较转化失败患者中位无进展生存期延长(31.0个月比9.9个月,P<0.001)。单因素分析发现,肝脏肿瘤双叶分布(P=0.003)、基线癌胚抗原水平升高(P=0.024)、肿瘤侵犯门静脉(P=0.001)、转移瘤数目>8个(P<0.001)、非FOLFOXIRI方案(P=0.005)以及未使用靶向治疗(P=0.038)是转化治疗失败的高危因素。多因素Logistic回归分析结果提示,转移瘤数目>8个(OR=2.422,95%CI:1.291~4.544,P=0.006)、门静脉侵犯(OR=2.727,95%CI:1.237~4.170,P=0.008)为影响初始不可切除的CRLM患者转化失败的独立危险因素,FOLFOXIRI方案(OR=0.300,95%CI:0.135~0.666,P=0.003)和使用靶向药(OR=0.411,95%CI:0.209~0.809,P=0.010)的使用为转化成功的独立保护因素。结论转移瘤数量和门静脉侵犯情况是影响初始不可切除的CRLM�Objective To investigate the factors affecting the success of conversion therapy in patients with initially unresectable colorectal cancer liver metastases(CRLM)in order to provide evidence-based medical evidence for formulating individualized treatment strategies for patients.Methods A retrospective case-control study was used in this study.Clinical data of 232 patients with initially unresectable CRLM receiving first-line systemic treatment in Sun Yat-sen University Cancer Center from January 2013 to January 2020 were collected,including 98 patients of successful conversion and 134 patients of failed conversion as control.Conversion therapy scheme:38 patients received FOLFOXIRI regimen chemotherapy(irinotecan,oxaliplatin,calcium folinate and fluorouracil),152 patients received FOLFOX regimen(oxaliplatin,calcium folinate and fluorouracil),19 patients received FOLRIRI regimen(irinotecan,calcium folinate and fluorouracil),23 patients received systemic chemotherapy combined with fluorouridine hepatic artery infusion chemotherapy;168 patients received targeted therapy,including 68 of bevacizumab and 100 of cetuximab.Logistics analysis was used to compare the factors affecting the success of conversion therapy.The Kaplan-Meier method was used to calculate progression-free survival(PFS),and the Log-rank test was used for survival comparison.Results Among 232 patients,98 patients had successful conversions and 134 patients had failed conversions with a successful conversion rate of 42.2%,meanwhile 30 patients underwent simple hepatectomy and 68 underwent hepatectomy combined with intraoperative radiofrequency ablation.After first-line chemotherapy,111 patients(47.8%)were partial remission,57 patients(24.6%)were stable disease,and 64 patients(27.6%)were progression disease.During the median follow-up of 18.8(1.0-87.9)months,148 patients were dead or with tumor progression.The median PFS time of patients with successful conversion was longer than that of patients with failed conversion(31.0 months vs.9.9 months,P<0.001).

关 键 词：结直肠癌 肝转移 初始不可切除 转化治疗 

分 类 号：R735.34[医药卫生—肿瘤]