Background

A uniform treatment strategy for patients suffering from early recurrence after local treatment of CRLM is currently lacking. The aim of this observational cohort study was to assess the potential survival benefit of repeat local treatment compared to systemic therapy in patients suffering from early recurrence of CRLM.

Patients and Methods

Patients who developed recurrent CRLM within 12 months after initial local treatment with curative intent were retrospectively identified in Amsterdam University Medical Centers between 2009-2019. Differences in overall and progression-free survival among treatment strategies were assessed using multivariable Cox regression analyses.

Results

A total of 135 patients were included. Median overall survival of 41 months [range 4-135] was observed in patients who received repeat local treatment, consisting of upfront or repeat local treatment after neoadjuvant systemic therapy, compared to 24 months [range 1-55] in patients subjected to systemic therapy alone (adjusted HR = 0.42 [95%-CI: 0.25-0.72]; P = .002). Prolonged progression-free survival was observed after neoadjuvant systemic therapy followed by repeat local treatment, as compared to upfront repeat local treatment in patients with recurrent CRLM within 4 months following initial local treatment of CRLM (adjusted HR = 0.36 [95%-CI: 0.15-0.86]; P = .021).

Conclusion

Patients with early recurrence of CRLM should be considered for repeat local treatment strategies. A multimodality approach, consisting of neoadjuvant systemic therapy followed by repeat local treatment, appeared favorable in patients with recurrence within 4 months following initial local treatment of CRLM.

中文翻译：

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结直肠癌肝转移早期复发患者重复局部治疗的生存获益

背景

目前缺乏针对 CRLM 局部治疗后早期复发患者的统一治疗策略。这项观察性队列研究的目的是评估与全身治疗相比，重复局部治疗对 CRLM 早期复发患者的潜在生存益处。

患者和方法

在 2009 年至 2019 年期间，在阿姆斯特丹大学医学中心回顾性地确定了在初始局部治疗后 12 个月内出现复发性 CRLM 的患者。使用多变量 Cox 回归分析评估治疗策略之间总体和无进展生存期的差异。

结果

共纳入 135 名患者。接受重复局部治疗（包括新辅助全身治疗后的前期或重复局部治疗）的患者中位总生存期为 41 个月 [范围 4-135]，而接受全身治疗的患者为 24 个月 [范围 1-55]单独（调整后的 HR = 0.42 [95%-CI: 0.25-0.72]；P  = .002）。与初始局部治疗后 4 个月内复发性 CRLM 患者的前期重复局部治疗相比，在新辅助全身治疗后重复局部治疗后观察到无进展生存期延长（调整后 HR = 0.36 [95%-CI: 0.15 -0.86]；P  = .021)。

结论

CRLM 早期复发的患者应考虑重复局部治疗策略。由新辅助全身治疗和重复局部治疗组成的多模式方法似乎对 CRLM 初始局部治疗后 4 个月内复发的患者有利。