Broj metastaza u jetri i prisustvo ekstrahepatične bolesti su prognostički parametri kod pacijenata sa operisanim metastazama kolorektalnog karcinoma u jetri nakon biološke i hemioterapije
Sažetak
Cilj: Utvrditi prognostičke parametre kod pacijenata sa metastazama kolorektalnog karcinoma u jetri (CLM) operisanih nakon biološke i hemioterapije, koja je dovela do resektabilnosti inicijalno neresektabilnih metastaza. Metode: Šezdeset šest pacijenata sa operativno lečenim CLM nakon primljene indukcione bio-hemioterapije bevacizumab + FOLFOX4, lečenih na Klinici za onkologiju Kliničkog centra Niš, u periodu od 2010. -2017. god. je uključeno. Preživljavanje bez bolesti (DFS) i ukupno preživljavanje (OS) procenjeni su korišćenjem Kaplan-Majer metode i poređeni korišćenjem log-rank testa, prema demografskim karakteristikama, karakteristikama bolesti i tretmana. Univarijantna COX regresiona analiza takođe je rađena. Rezultati: DFS je bilo značajno duže kod pacijenata sa do 4 CLM u odnosu na one sa 5 ili više CLM (18,384 v.s. 6,85 meseci; p<0,001). Značajno duže OS bilo je prisutno kod pacijenta sa do 4 CLM nego kod onih sa 5 ili više CLM (44,687 v.s. 29,723 meseci; p=0,006) kao i kod pacijenata bez ekstrahepatične bolesti (41,71 v.s. 23,283 meseci; p=0,012). Univarijantna analiza pokazuje da je 5 ili više CLM prediktor lošijeg DFS (HR 3,989; 95%CI 1,055-15,087; p=0,042), a odsustvo ekstrahepatatične bolesti je prediktor boljeg OS (HR 0,122; 95%CI 0,017-0,869; p=0,036). Diskusija: Rezultati ovog istraživanja slažu se sa rezultatima prethodnih velikih studija kod pacijenata sa operisanim CLM. Zaključak: Broj CLM i prisustvo ekstrahepatične bolesti su prognostički parametri kod pacijenata sa operisanim CLM nakon konverzione bio-hemioterapije.
Reference
Baldessari C, Spallanzani A, Gelsomino F, et al. Outcome and prognostic factors after resection of liver metastases in patients with colorectal cancer. Ann Oncol 2017; 28(6): vi13-vi14. Available at: https://doi.org/10.1093/annonc/mdx422.036
Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2018; 68(6): 394–424. Available at: https://doi.org/10.3322/caac.21492.
Doci R, Gennari L, Bignami P, et al. One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg 1991; 78: 797–801. Available at: https://doi.org/10.1002/bjs.1800780711
Donadon M, Lleo A, Di Tommaso L, et al. The Shifting Paradigm of Prognostic Factors of Colorectal Liver Metastases: From Tumor Centered to Host Immune-Centered Factors. Front Oncol 2018; 8: 181. Available at: https://doi.org/10.3389/fonc.2018.00181.
Dzunic M, Andjelkovic-Apostolovic M, Vrbic S et al. Survival of patients with liver metastases from colorectal cancer treated with bevacizumab and FOLOFOX4. J BUON 2020; 25(1): 212-19.
Dzunic M, Petkovic I, Cvetanovic A, et al. Current and future targets and therapies in metastatic colorectal cancer. J BUON 2019; 24(5): 1785-92.
Engstrand J, Nilsson H, Strömberg C, et al. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer 2018; 18(1): 78. Available at: https://doi.org/10.1186/s12885-017-3925-x.
Fong Y, Fortner J, Sun RL et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230: 309–318; discussion 318–321. Available at: https://doi.org/10.1097/00000658-199909000-00004
Horowitz M, Neeman E, Sharon E, and Ben-Eliyahu S. Exploiting the critical perioperative period to improve longterm cancer outcomes. Nature Reviews Clinical Oncology. 2015; 12(4): 213–226. Available at: https://doi.org/10.1038/nrclinonc.2014.224.
de Haas RJ, Wicherts DA, Salloum C et al. Long term outcomes after hepatic resection for colorectal metastases in young patients. Cancer 2010; 116: 647-58. Available at: https://doi.org/10.1002/cncr.24721.
Imai K, Adam R, Baba H. How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective. Ann Gastroenterol Surg 2019; 3(5): 476-86. Available at: https://doi.org/10.1002/ags3.12276.
Lieu CH, Renfro LA, de Gramont A et al. Association of age with survival in patients with metastatic colorectal cancer: analysis from the ARCAD Clinical Trials Program. J Clin Oncol 2014; 32: 2975-84. Available at: https://doi.org/10.1200/JCO.2013.54.9329
Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results of our experience. Ann Surg 2000; 23: 487–99. Available at: https://doi.org/10.1097/00000658-200004000-00006
Neeman E and Ben-Eliyahu S. Surgery and stress promote cancer metastasis: new outlooks on perioperative mediating mechanisms and immune involvement. Brain Behav Immun 2013; 30: S32-40. Available at: https://doi.org/10.1016/j.bbi.2012.03.006.
Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorec-tal carcinoma: impact of surgical resection on the natural history. Br J Surg 1990; 77: 1241–6. Available at: https://doi.org/10.1002/bjs.1800771115
Taylor M, Forster J, Langer B, et al. A study of prognostic factors for hepatic resection for colorectal metastases. Am J Surg. 1997; 173: 467–71. Available at: https://doi.org/10.1016/S0002-9610(97)00020-2.
Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27(8): 1386-422. Available at: https://doi.org/10.1093/annonc/mdw235.
Wang Z, Wang X, Zhang Z, et al. Association between Primary Tumor Location and Prognostic Survival in Synchronous Colorectal Liver Metastases after Surgical Treatment: A Retrospective Analysis of SEER Data. J Cancer 2019; 10(7): 1593-1600. Available at: https://doi.org/10.7150/jca.29294