同时性结直肠癌肝转移瘤消融治疗后辅助化疗起始时间对患者预后的影响

目的本研究以探究微波消融（MWA）治疗后辅助化疗（AC）起始时间对同时性结直肠癌肝转移瘤（CRLM）患者肝内无复发生存（RFS）及肝损害的影响。 方法回顾性分析2013年10月至2019年1月在中山大学附属第六医院确诊为同时性CRLM且行超声引导下经皮MWA治疗联合AC治疗的患者。本研究共纳入患者144例，其中G1组98例，G2组46例。中位肝内RFS为22.2个月。根据MWA术后AC开始时间，将患者分为≤4周（G1）和4~8周（G2）2组。比较G1组和G2组消融后及第1次AC前后血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平的变化。采用Kaplan-Meier法和Log-rank检验计算并比较两组患者的肝内RFS。采用Cox比例风险模型对肝内RFS的危险因素进行单因素和多因素回归分析。 结果G1组肝内RFS较G2组显著延长（中位肝内RFS，40.6个月 vs 12.6个月，Log-rank P=0.007）。采用Cox比例风险模型分析结果发现,辅助化疗开始时间间隔为4~8周（HR=1.917，95%CI：1.104~3.327，P=0.021）和肝转移瘤个数（HR=1.292，95%CI：1.096~1.524，P=0.002）是肝内RFS时间短的独立影响因素。G1组和G2组第1次AC前、后ALT、AST水平，差异均无统计学意义（P均>0.05）。 结论对于同时性CRLM患者，在MWA治疗后早期开始AC（≤4周）有助于延长术后肝内RFS时间。

Effect of time of initiating adjuvant chemotherapy on prognosis of patients with synchronous colorectal liver metastasis after microwave ablation

ObjectiveTo investigate the influence of time of initiating adjuvant chemotherapy (AC) on intrahepatic recurrence-free survival (RFS) and liver injury in patients with synchronous colorectal liver metastasis (CRLM) after receiving microwave ablation (MWA). MethodsData were retrospectively collected from patients with synchronous CRLM undergoing ultrasound-guided percutaneous MWA combined with AC at our center from October 2013 to January 2019. According to the time of initiating AC relative to the date of MWA, the patients were categorized into two groups:≤4 weeks (G1) and 4~8 weeks (G2). Kaplan-Meier method and log-rank test were used to compare the RFS between the two groups. Cox regression models were used for univariate and multivariate analyses to identify predictors of RFS. Besides, the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) before and after the first AC were also compared between the G1 and G2 groups. ResultsA total of 144 patients were included in this study (G1, n=98; G2, n=46). Median RFS was 22.2 months. The RFS was significantly longer in the G1 group than in the G2 group (median RFS, 40.6 months vs 12.6 months, log-rank P=0.007). In Cox regression analysis, G2 (hazard ratio [HR]=1.917, 95% confidence interval CI: 1.104-3.327, P=0.021) and the number of tumors (HR=1.292, 95%CI: 1.096-1.524, P=0.002) were independent predictors of shorter RFS. There was no difference in ALT or AST level between the G1 and G2 groups before and after the first AC (P>0.05). ConclusionFor synchronous CRLM patients, receiving AC within 4 weeks after MWA may be beneficial to longer RFS.