Anatomical resection improve relapse-free survival in colorectal liver metastases patients with KRAS/NRAS/BRAF mutation or right-sided colon cancer: a retrospective cohort study

医学 克拉斯 神经母细胞瘤RAS病毒癌基因同源物 危险系数 结直肠癌 内科学 回顾性队列研究 比例危险模型 肿瘤科 胃肠病学 肝切除术 队列 切除术 癌症 外科 置信区间
作者
Wenju Chang,Yijiao Chen,Shizhao Zhou,Ren Li,Yu Xu,Dexiang Zhu,Wentao Tang,Qing-Hai Ye,Xiaoying Wang,Jun Fan,Wei Ye,Jianmin Xu
出处
期刊:International Journal of Surgery [Wolters Kluwer]
标识
DOI:10.1097/js9.0000000000000562
摘要

The type of liver resection (anatomical resection, AR or nonanatomical resection, NAR) for colorectal liver metastases (CRLM) is subject to debate. The debate may persist because some prognostic factors, associated with aggressive tumor biological behavior, have been overlooked.Our study aimed to investigate the characteristics of patients who would benefit more from anatomical resection for CRLM.729 patients who underwent hepatic resection of CRLM were retrospectively collected from June 2012 and May 2019. Treatment effects between AR and NAR were compared in full subgroup analyses. Tumor relapse-free survival (RFS) was evaluated by a stratified log-rank test and summarized with the use of Kaplan-Meier and Cox proportional hazards methods.Among 729 patients, 235 (32.2%) underwent AR and 494 (67.8%) underwent NAR, we showed the favorable trends in RFS for AR compared with NAR in the patients with KRAS/NRAS/BRAF mutation (interaction P <0.001) or right-sidedness (interaction P <0.05). Patients who underwent AR had a markedly improved RFS compared with NAR, in the cohorts of RAS/NRAS/BRAF mutation (median RFS 23.2 VS 11.1 months, P <0.001) or right-sidedness (median RFS 31.6 VS 11.5 months, P <0.001); upon the multivariable analyses, AR (gene mutation: hazard ratio [HR] =0.506, 95% CI = 0.371-0.690, P <0.001; right-sidedness: HR =0.426, 95% CI =0.261-0.695, P =0.001) remained prognostic independently. In contrast, patients who underwent AR had a similar RFS compared with those who underwent NAR, in the cohorts of patients with gene wild-type tumors (median RFS 20.5 VS 21.6 months, P =0.333). or left-sidedness (median RFS 15.8 VS 19.5 months, P =0.294).CRLM patients with gene mutation or right-sidedness can benefit more from AR rather than from NAR.
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