Background

For patients with initially unresectable colorectal liver metastasis (IU-CRLM) receiving conversion therapy, disease relapse after conversion hepatectomy is common. However, few studies have focused on the assessment and management of relapse following conversion hepatectomy for IU-CRLM.

Methods

In the retrospective cohort study, 255 patients with IU-CRLM received conversion therapy and underwent subsequent R0 resection. The treatment effects of repeated liver-directed treatment (RLDT) versus non-RLDT for liver relapse were examined. Survival analysis was evaluated with the use of Cox proportional hazards methods. The importance of RLDT was further confirmed in the propensity score matching (PSM) and subgroup analyses.

Results

The 5-year overall survival (OS) rate after conversion hepatectomy was 34.9%. Liver relapse was observed in 208 patients. Of these patients, 106 underwent RLDT (65 underwent repeated hepatectomy and the remainder underwent ablation treatment), while 102 received only palliative chemotherapy. The relapse patients who underwent RLDT had a significantly longer OS than those who did not (hazard ratio (HR): 0.382, 95% CI: 0.259-0.563; P<0.001). In a multivariable analysis, RLDT was independently associated to prolonged survival (HR: 0.309, 95%CI: 0.181-0.529; P<0.001). In the PSM and subgroup analyses, RLDT consistently showed evidence of prolonging OS significantly.

Conclusion

For IU-CRLM patients with liver relapse following conversion hepatectomy, the RLDT is essential for cure and prolonged survival. To avoid missing the opportunity for RLDT, intensive disease surveillance should be proposed.

中文翻译：

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手术治疗对最初不可切除的结直肠肝转移转肝切除术后复发的影响：一项回顾性队列研究

背景

对于最初不可切除的结直肠肝转移（IU-CRLM）接受转化治疗的患者，转化肝切除术后疾病复发很常见。然而，很少有研究关注 IU-CRLM 肝切除术后复发的评估和管理。

方法

在回顾性队列研究中，255 名 IU-CRLM 患者接受了转换治疗并随后接受了 R0 切除术。研究了重复肝脏定向治疗 (RLDT) 与非 RLDT 对肝脏复发的治疗效果。使用 Cox 比例风险方法评估生存分析。RLDT 的重要性在倾向评分匹配（PSM）和亚组分析中得到进一步证实。

结果

中转肝切除术后的 5 年总生存 (OS) 率为 34.9%。在 208 名患者中观察到肝脏复发。在这些患者中，106 名患者接受了 RLDT（65 名患者接受了重复肝切除术，其余患者接受了消融治疗），而 102 名患者仅接受了姑息性化疗。接受RLDT的复发患者的OS明显长于未接受RLDT的患者（风险比（HR）：0.382，95% CI：0.259-0.563；P<0.001）。在多变量分析中，RLDT 与生存期延长独立相关（HR：0.309，95%CI：0.181-0.529；P <0.001）。在 PSM 和亚组分析中，RLDT 始终显示出显着延长 OS 的证据。

结论

对于肝切除术后肝脏复发的 IU-CRLM 患者，RLDT 对于治愈和延长生存至关重要。为了避免错过 RLDT 的机会，应建议加强疾病监测。