背景:尽管一些数据表明患有mutRAS结直肠肝转移(CRLM)的患者可能从解剖性肝切除术中受益,这个话题仍然有争议。我们进行了系统评价和荟萃分析,以确定RAS突变状态是否与手术技术相关的预后相关[解剖切除(AR)与CRLM患者的非解剖切除(NAR)]。
方法:对研究进行了系统评价和荟萃分析,以研究AR和NAR与总体和肝脏特异性无病生存率的关系(DFS和肝脏特异性DFS,分别)在RAS突变状态的背景下。
结果:总体而言,2018年患者(831例mutRASvs.1187wtRAS)纳入了五项符合条件的研究。AR与肝脏特异性DFS改善40%相关[风险比(HR)=0.6,95%置信区间(CI)0.44-0.81,p=0.01]和总体DFS改善28%(HR=0.72,95%CI0.54-0.95,p=0.02)在患有mutRAS肿瘤的患者中;相比之下,AR与WTRAS患者肝脏特异性DFS或总体DFS的任何改善无关。这些差异可能是由接受AR和NAR的mutRAS肿瘤患者中R1切除术的发生率降低了40%介导的[相对风险(RR):0.6,95%CI0.40-0.91,p=0.02]。相比之下,在接受AR和NAR的wtRAS患者中,R1切除的概率没有降低(RR:0.93,95%CI0.69~1.25,p=0.62).
结论:数据提示精准手术可能与CRLM相关。具体来说,而不是所有患者的实质保留教条,AR可能在患有mutRAS肿瘤的个体中起作用。
BACKGROUND: Although some data suggest that patients with mutRAS colorectal liver metastases (CRLM) may benefit from anatomic hepatectomy, this topic remains controversial. We performed a systematic review and meta-analysis to determine whether RAS mutation status was associated with prognosis relative to surgical technique [anatomic resection (AR) vs. nonanatomic resection (NAR)] among patients with CRLM.
METHODS: A systematic review and meta-analysis of studies were performed to investigate the association of AR versus NAR with overall and liver-specific disease-free survival (DFS and liver-specific DFS, respectively) in the context of RAS mutation status.
RESULTS: Overall, 2018 patients (831 mutRAS vs. 1187 wtRAS) were included from five eligible studies. AR was associated with a 40% improvement in liver-specific DFS [hazard ratio (HR) = 0.6, 95% confidence interval (CI) 0.44-0.81, p = 0.01] and a 28% improvement in overall DFS (HR = 0.72, 95% CI 0.54-0.95, p = 0.02) among patients with mutRAS tumors; in contrast, AR was not associated with any improvement in liver-specific DFS or overall DFS among wtRAS patients. These differences may have been mediated by the 40% decreased incidence in R1 resection among patients with mutRAS tumors who underwent AR versus NAR [relative risk (RR): 0.6, 95% CI 0.40-0.91, p = 0.02]. In contrast, the probability of an R1 resection was not decreased among wtRAS patients who underwent AR versus NAR (RR: 0.93, 95% CI 0.69-1.25, p = 0.62).
CONCLUSIONS: The data suggest that precision surgery may be relevant to CRLM. Specifically, rather than a parenchymal sparing dogma for all patients, AR may have a role in individuals with mutRAS tumors.