背景:本研究旨在评估多个肝转移的大小差异对结直肠癌肝转移(CRLM)肝切除术患者肝无复发生存期(RFS)的影响。
方法:总的来说,回顾性分析2010年1月至2016年12月接受肝切除术的147例CRLM患者。肿瘤大小比(TSR)定义为最大肝脏病变的最大直径超过最小肝脏病变的最大直径。进行单因素和多因素分析以确定独立的预后危险因素。在每个肿瘤负担评分(TBS)区中进一步探索TSR的预后价值。使用Log-rank生存分析来比较新临床评分和Fong临床评分中的肝脏RFS。
结果:基于TSR,患者分为3组:TSR<2,2≤TSR<4和TSR≥4.根据多变量分析,2-4的TSR(危险比[HR],2.580;95%置信区间[CI]1.543-4.312;P<0.001)和TSR<2(HR,4.435;95%CI2.499-7.872;P<0.001)与肝脏RFS恶化相关。随着TSR的降低,肝脏RFS恶化。TSR可以根据TBS标准进一步将1区和2区的患者分为不同的风险组(1区:中位肝脏RFS,第1组和第2组分别为3.2和8.9个月,P=0.003;第2区:中位肝RFS,第1、2和3组分别为3.5、5.0和10.9个月,P<0.05)。新临床评分的预测能力,其中包括TSR,优于方临床评分。
结论:TSR,作为预测工具,在接受CRLM肝切除术的患者中,可以准确评估多个肝转移瘤大小差异对肝RFS的影响。
背景:回顾性登记。
BACKGROUND: The study aimed to assess the impact of size differences of multiple liver metastases on liver recurrence-free survival (RFS) in patients undergoing hepatic resection for colorectal liver metastases (CRLMs).
METHODS: Overall, 147 patients with CRLMs who underwent hepatic resection between January 2010 and December 2016 were retrospectively analysed. Tumour size ratio (TSR) was defined as the maximum diameter of the largest liver lesion over the maximum diameter of the smallest liver lesion. The univariate and multivariate analyses were performed to determine independent prognostic risk factors. The prognostic value of the TSR was further explored in each Tumour Burden Score (TBS) zone. Log-rank survival analyses were used to compare liver RFS in the new clinical score and the Fong clinical score.
RESULTS: Based on the TSR, patients were classified into three groups: TSR < 2, 2 ≤ TSR < 4, and TSR ≥ 4. According to the multivariate analysis, TSR of 2-4 (hazard ratio [HR], 2.580; 95% confidence interval [CI] 1.543-4.312; P < 0.001) and TSR < 2 (HR, 4.435; 95% CI 2.499-7.872; P < 0.001) were associated with worse liver RFS. As TSR decreased, liver RFS worsened. TSR could further stratify patients in zones 1 and 2 into different risk groups according to the TBS criteria (zone 1: median liver RFS, 3.2 and 8.9 months for groups 1 and 2, respectively, P = 0.003; zone 2: median liver RFS, 3.5, 5.0, and 10.9 months for groups 1, 2, and 3, respectively, P < 0.05). The predictive ability of the new clinical score, which includes TSR, was superior to that of the Fong clinical score.
CONCLUSIONS: TSR, as a prognostic tool, could accurately assess the effect of size differences across multiple liver metastases on liver RFS in patients undergoing hepatectomy for CRLMs.
BACKGROUND: Retrospectively registered.