Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis

Autor: Antonio Iannelli, Antonio Sa cunha, Fabrice Muscari, Pietro ADDEO, Nicola De'Angelis, Antoine Brouquet, JEAN ROBERT DELPERO, Olivier Turrini, Astrid Herrero, Olivier Glehen, Maximiliano Gelli, Dimitrios Ntourakis, Tullio Piardi
Přispěvatelé: L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Institut de Recherche Contre les Cancers de l'Appareil Digestif-European Institute of Telesurgery (IRCAD/EITS), CHU Strasbourg, Hôpital Paul Brousse, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Département de chirurgie viscérale [Gustave Roussy], Institut Gustave Roussy (IGR), Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Oncology
Male
MESH: Retrospective studies
MESH: Margins of Excision
medicine.medical_treatment
MESH: Liver Neoplasms / surgery
030230 surgery
Gastroenterology
Metastasis
0302 clinical medicine
Risk Factors
MESH: Colorectal Neoplasms / pathology
MESH: Aged
Liver Neoplasms
Margins of Excision
Middle Aged
MESH: Hepatectomy
Prognosis
Primary tumor
MESH: Adenocarcinoma / secondary
MESH: Middle aged
030220 oncology & carcinogenesis
Resection margin
Adenocarcinoma
Female
Colorectal Neoplasms
MESH: Survival analysis
Adult
medicine.medical_specialty
MESH: Adenocarcinoma / surgery
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
MESH: Risk factors
MESH: Multivariate Analysis
MESH: Prognosis
03 medical and health sciences
MESH: Liver Neoplasms / secondary
Internal medicine
medicine
Hepatectomy
Humans
MESH: Colorectal Neoplasms / mortality
Propensity Score
Survival analysis
Aged
Retrospective Studies
MESH: Humans
business.industry
MESH: Adenocarcinoma / mortality
Retrospective cohort study
MESH: Adult
medicine.disease
Survival Analysis
MESH: Male
MESH: Liver Neoplasms / mortality
MESH: Propensity score
Propensity score matching
Multivariate Analysis
Surgery
business
MESH: Female
Zdroj: World Journal of Surgery
World Journal of Surgery, Springer Verlag, 2018, 42 (3), pp.892-901. ⟨10.1007/s00268-017-4229-7⟩
World Journal of Surgery, 2018, 42 (3), pp.892-901. ⟨10.1007/s00268-017-4229-7⟩
ISSN: 0364-2313
1432-2323
Popis: The width of resection margin is still a matter of debate in case of colorectal liver metastasis resection. The aim of this study was to determine the risk factors for R1 resection. Once risk factors had been identified, patients were matched according to Fong’s prognostic criteria, in order to evaluate whether R1 resection still remained a negative prognostic factor impacting overall and disease-free survival. A total of 1784 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were compared before and after a 1:1 propensity score analysis in order to compare R0 versus R1 resections according to Fong criteria. Primary tumor nodes found positive after colorectal resection (RR = 1.20, p = 0.02), operative time (> 240 min) (RR = 1.26, p = 0.05), synchronous liver metastasis (RR = 1.27, p = 0.02), pedicle clamping (> 40 min) (RR = 1.52, p = 0.001), lesion size larger than 50 mm (RR = 1.54, p = 0.001), rehepatectomy (RR = 1.68, p = 0.001), more than 3 lesions (RR = 1.69, p = 0.0001), and bilateral lesions (RR = 1.74, p = 0.0001) were identified as risk factors in multivariate analysis. After a 1:1 PSM according to Fong criteria, R1 resection still remained a negative prognostic factor impacting overall and disease-free survival, with 1-, 3-, 5-year OS at 94, 81, and 70% in R0 and 92, 75, and 58% in R1, respectively, (p = 0.008), and disease-free survival (DFS) with 1-, 3-, 5-year survival at 64, 41, and 28% in R0 versus 51, 28, and 18% in R1 (p = 0.0002), respectively. Even after using PSM as an oncological prognostic criterion, R1 resection still impacts overall and disease-free survival negatively.
Databáze: OpenAIRE
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