Background: Assessing patients with colorectal cancer liver metastases (CRCLM) by a liver multidisciplinary team (MDT) results in higher resection rates and improved survival. The aim of this study was to evaluate the potentially improved resection rate in a defined cohort if all patients with CRCLM were evaluated by a liver MDT.
Patients and methods: A retrospective analysis of patients diagnosed with colorectal cancer during 2008 in the greater Stockholm region was conducted. All patients with liver metastases (LM), detected during 5-year follow-up, were re-evaluated at a fictive liver MDT in which previous imaging studies, tumor characteristics, medical history, and patients' own treatment preferences were presented. Treatment decisions for each patient were compared to the original management. Odds ratios (ORs) and 95% confidence intervals were estimated for factors associated with referral to the liver MDT.
Results: Of 272 patients diagnosed with LM, 102 patients were discussed at an original liver MDT and 69 patients were eventually resected. At the fictive liver MDT, a further 22 patients were considered as resectable/potentially resectable, none previously assessed by a hepatobiliary surgeon. Factors influencing referral to liver MDT were age (OR 3.12, 1.72-5.65), American Society of Anaesthesiologists (ASA) score (OR 0.34, 0.18-0.63; ASA 2 vs. ASA 3), and number of LM (OR 0.10, 0.04-0.22; 1-5 LM vs. >10 LM), while gender (p = .194) and treatment at a teaching hospital (p = .838) were not.
Conclusion: A meaningful number of patients with liver metastases are not managed according to best available evidence and the potential for higher resection rates is substantial.
Implications for practice: Patients with liver metastatic colorectal cancer who are assessed at a hepatobiliary multidisciplinary meeting achieve higher resection rates and improved survival. Unfortunately, patients who may benefit from resection are not always properly referred. In this study, the potential improved resection rate was assessed by re-evaluating all patients with liver metastases from a population-based cohort, including patients with extrahepatic metastases and accounting for comorbidity and patients' own preferences towards treatment. An additional 12.9% of the patients were found to be potentially resectable. The results highlight the importance of all patients being evaluated in the setting of a hepatobiliary multidisciplinary meeting.
摘要
背景. 由肝脏多学科专家组（MDT）对结直肠癌肝转移（CRCLM）患者进行评估后, 患者的切除率提高且生存期有所改善。本研究旨在评估若一个规定队列中的所有CRCLM患者均接受肝脏MDT评价时的潜在切除率提高水平。
患者和方法. 针对2008年大斯德哥尔摩地区诊断为结直肠癌的患者进行了一项回顾性分析。在5年随访期间检出肝转移（LM）的所有患者均由本研究的肝脏MDT重新进行评价, 评价时提供既往影像学研究结果、肿瘤特征、病史和患者本人的治疗偏好。将每例患者的治疗决策与原始治疗方案进行比较。估算与转诊肝脏MDT相关的各项因素的比值比（OR）和95%置信区间。
结果. 在诊断为LM的272例患者中, 102例最初由肝脏MDT进行了会诊, 其中69例最终行切除术。本研究的肝脏MDT评估后认为, 另有22例患者也属于可切除/潜在可切除患者, 而这些患者之前未由肝胆外科医生进行评估。转诊肝脏MDT的影响因素包括年龄（OR 3.12, 1.72‐5.65）、美国麻醉医师协会（ASA）评分（OR 0.34, 0.18‐0.63；ASA 2 vs. ASA 3）和LM数量（OR 0.10, 0.04‐0.22；1‐5 LM vs. >10 LM）, 而性别（p=0.194）和在教学医院接受治疗（p=0.838）并非影响因素。
结论. 大量肝转移患者未遵循最佳可用证据接受治疗, 切除率的潜在提高空间相当大。
Keywords: Colorectal cancer; Extrahepatic metastases; Hepatobiliary multidisciplinary teams; Imaging; Liver metastases.
© AlphaMed Press 2017.