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Recent advances in liver metastasis in colorectal cancer
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Recurrence pattern after liver metastases in colorectal cancer predicts survival
The keynote speaker of this issue is Bao Quan, deputy chief physician
introduction
Surgical resection is an effective means for patients with colorectal cancer liver metastases (CRLM) to achieve long-term survival, with a 5-year survival rate of 58% and a 10-year survival rate of 26%. However, the main problem faced after CRLM surgery is the high recurrence rate, which reaches 74% within 2 years, which is the leading cause of postoperative death in CRLM patients. Many clinicopathological factors have been found to correlate with postoperative survival, but these factors are only partially predictive of survival and may change over the long-term course of the disease. Therefore, these indicators are not necessarily very accurate for the judgment of recurrence after CRLM surgery. The time and site of recurrence in CRLM patients reflect the biological behavior of tumors, so understanding recurrence patterns is of great significance for predicting disease progression and formulating appropriate treatment strategies. Therefore, this study explores the prognostic significance of recurrence time and location in patients undergoing CRLM surgery for radical treatment through retrospective analysis.
Research methods
The study included CRLM patients who underwent R0/R1 resection at Royal Australian North Shore Hospital from 2007 to 2017. Follow-up was at least 6 months. The patient's clinicopathological factors were recorded, including age, sex, primary lesion site, lymph node metastasis status, liver metastasis onset, CEA level, genetic status, and TMB. Early recurrence is defined as recurrence or metastasis within 6 months of CRLM surgery.
Study results
A total of 194 patients were included in the study. The median follow-up was 85.3 months, 145 patients (74.7%) had relapse, median survival was 64.6 months, and the 5-year survival rate was 54.1%. The median survival time after recurrence was 28.9 months, and the 5-year survival rate was 28.8% (Fig 2).
Early relapse occurred in 58 patients (29.9%); Long-term survival was significantly different between early and late relapse survival (25.9 versus 53.1 percent, p<0.001).
Postoperative recurrence sites included: limited to liver in 53 cases (36.5%); 48 cases (33.1%) were with multiple organs; limited to pulmonary 30 cases (20.7%); Other isolated extrahepatic metastases were 14 (9.6%). The median survival time after surgery in patients with lung-only metastasis, liver-only metastasis and multi-organ metastasis was 75.4, 43.5 and 31 months, respectively.
Multivariate analysis found that early recurrence, site of recurrence and KRAS mutation were independent prognostic factors affecting survival after CRLM surgery.
discuss
The expansion of the resectable criteria for CRLM has broadened the options for surgical patients, but with it comes a high postoperative recurrence rate. The time, location and status of KRAS gene after surgery reflect the tumor biological behavior of CRLM patients, and to a certain extent, they can predict the long-term survival of CRLM. Some clinicopathological factors or perioperative chemotherapy responses did not show prognostic value in patients after CRLM surgery, suggesting that there are still many unknowns about the biological behavior of tumors.
Early recurrence is an important indicator of postoperative survival in patients with CRLM. At present, the time of early recurrence is generally defined within 6 months, so it is recommended to closely monitor the clinical indicators of patients within 6 months after surgery, and early detection of recurrence and reasonable treatment are of great significance for improving the survival of patients with recurrent CRLM.
Different sites of metastases also have an impact on prognosis, with the liver being the most common site of recurrence. However, most are new metastases elsewhere in the liver, and the likelihood of local recurrence due to R1 margins is low. This is mainly due to the fact that the electrical device will ablate and inactivate a certain margin width when it is separated from the liver parenchyma, and if distant metastasis due to positive resection margins indicates poor biological behavior of the tumor. The prognosis of recurrence of lung metastases alone was good, with survival of 36 months after recurrence; The prognosis of multiple organ metastasis was the worst, with a median survival of only 13 months. Therefore, for metastasis recurrence confined to the liver, lungs, and peritoneum, it is generally recommended to actively carry out local treatment when possible; For recurrent metastasis of multiple organs, systemic drug treatment is the mainstay, unless it is resectable recurrent liver metastasis that only retains unresectable lung metastases with less burden, and these patients may benefit from surgical survival.
The heterogeneity of tumors is reflected in the heterogeneity of CRLM recurrence, and it was further found that the recurrence time and initial recurrence site are the prognostic factors affecting the survival of CRLM patients with radical curative treatment. Preoperative clinicopathological factors still have certain limitations in predicting survival after recurrence, and further exploration and discovery in the molecular field is needed in the future to find molecular markers that more accurately predict the prognosis of CRLM.
END
Past is wonderful
Laparoscopically versus the long-term prognosis of laparotomy in liver metastases in colorectal cancer: a randomized controlled study
Gene stratification guides resectable colorectal cancer liver metastases and postoperative adjuvant therapy and predicting survival
Minimally invasive liver resection for the treatment of liver metastases of colorectal cancer - SIMMIR study
Colorectal cancer liver metastases: ADC as an imaging marker for tumor biological behavior and treatment response
Stratified gene expression profiling predicts survival after liver metastases in colorectal cancer
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