Value of conversion therapy in treatment of patients with colorectal cancer liver metastasis

doi:10.3877/cma.j.issn.2095-3232.2021.04.013

Abstract

Abstract:

Objective

To explore the value and influencing factors of conversion therapy in the treatment of patients with colorectal cancer liver metastasis (CRLM).

Methods

Clinical data of 78 CRLM patients admitted to Peking University People's Hospital from January 2011 to June 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 51 patients were male and 27 female, aged 39-77 years with a median age of 58 years. According to the assessment result of liver metastases, primary resection of primary lesions and liver metastases combined with postoperative chemotherapy were performed in patients with initially resectable tumors. Patients with initially unresectable tumors were treated with conversion therapies of bevacizumab combined with XELOX regimen or cetuximab combined with FOLFIRI regimen. Patients who successfully received conversion therapy underwent surgery-based comprehensive treatments. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influencing factors of successful conversion therapy were analyzed by Chi-square test.

Results

40 patients were diagnosed with initially resectable tumors and38 cases of initially unresectable tumors. The success rate of CRLM conversion therapy was 32%(12/38), including 5 cases of hepatectomy, 6 cases of hepatectomy combined with radiofrequency ablation, and 1 case of portal vein ligation and secondary hepatectomy. The median survival of patients with initially resectable and unresectable tumors was 36 and 17 months, respectively, where significant difference was observed (χ²=57.423, P<0.05). The median survival of patients who received successful and unsuccessful conversion therapy was 20 and 15 months, respectively, where significant difference was observed (χ²=4.487, P<0.05). The conversion rates of patients with the maximal diameter of liver metastases < 6 cm and the number ≤ 4 were 50%(8/16) and 50%(9/18), significantly higher than 18%(4/22) and 15%(3/20) in the control group (χ²=4.340, 5.371; P<0.05).

Conclusions

Conversion therapy can significantly improve the survival and prognosis of CRLM patients. The diameter and number of liver metastases are critical factors affecting the conversion rate of CRLM patients. Surgical resection-based comprehensive treatment plays a critical role in enhancing the clinical efficacy of CRLM patients.

Key words: Colorectal neoplasms, Neoplasm metastasis, Conversion therapy

Rui Ma, Tao Li. Value of conversion therapy in treatment of patients with colorectal cancer liver metastasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(04): 398-402.

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References 21

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参数		例数	转化者	未转化者	χ²值	P值
性别					0.433	0.510
	男	25	7（28）	18（72）
	女	13	5（38）	08（62）
年龄					0.661	0.416
	<60岁	13	3（23）	10（77）
	≥60岁	25	9（36）	16（64）
原发灶部位					1.810	0.405
	左半结肠	18	7（39）	11（61）
	右半结肠	12	2（17）	10（83）
	直肠	8	3（38）	05（62）
肿瘤分化程度					2.763	0.096
	中高分化	17	3（18）	14（82）
	低分化	21	9（43）	12（57）
转移灶最长径					4.340	0.037
	≥6 cm	22	4（18）	18（82）
	<6 cm	16	8（50）	08（50）
转移灶数目					5.371	0.020
	>4个	20	3（15）	17（850）
	≤4个	18	9（50）	09（50）
CEA					0.001	0.970
	≥10 μg/L	16	5（31）	11（69）
	<10 μg/L	22	7（32）	15（682）
贫血					0.229	0.632
	是	18	5（28）	13（72）
	否	20	7（35）	13（65）

参数		例数	转化者	未转化者	χ²值	P值
性别					0.433	0.510
	男	25	7（28）	18（72）
	女	13	5（38）	08（62）
年龄					0.661	0.416
	<60岁	13	3（23）	10（77）
	≥60岁	25	9（36）	16（64）
原发灶部位					1.810	0.405
	左半结肠	18	7（39）	11（61）
	右半结肠	12	2（17）	10（83）
	直肠	8	3（38）	05（62）
肿瘤分化程度					2.763	0.096
	中高分化	17	3（18）	14（82）
	低分化	21	9（43）	12（57）
转移灶最长径					4.340	0.037
	≥6 cm	22	4（18）	18（82）
	<6 cm	16	8（50）	08（50）
转移灶数目					5.371	0.020
	>4个	20	3（15）	17（850）
	≤4个	18	9（50）	09（50）
CEA					0.001	0.970
	≥10 μg/L	16	5（31）	11（69）
	<10 μg/L	22	7（32）	15（682）
贫血					0.229	0.632
	是	18	5（28）	13（72）
	否	20	7（35）	13（65）

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