| Background: Conversion therapy is an important stage to achieve long-term survival of patients with colorectal cancer with unresectable liver metastasis,but the related factors affecting the prognosis and the optimal conversion therapy are still unclear.Objective: 1.The purpose of this study is to investigate the efficacy and prognosis of conversion therapy in patients with colorectal cancer with unresectable simultaneous liver metastasis and to establish a predictive model.2.to explore the factors affecting the success of conversion therapy.Methods: A retrospective cohort study was used in this study,which included170 patients with colorectal cancer complicated with liver metastasis from Gastrointestinal Surgery Center,The First Affiliated Hospital of Nanchang University from January 2015 to December 2020.After discussion in MDT,patients were divided into an initial resectable group(42 cases)and an initial non-resectable group(128 cases).The clinical data of 128 cases with unresectable diseases were collected.Kaplan-Meier method and COX regression were used to analyze the factors affecting the prognosis and the factors affecting the successful conversion.The selected prognosis indicators were adopted and the nomogram was constructed with R software to predict the1-,2-and 3-year survival rates of patients and establish the prediction model,which was verified by the standard curve and consistency index.P<0.05 difference was statistically significant.Results:(1)The results of 128 cases of conversion therapy were divided into three groups: 1)30 cases in the successful conversion group,with the primary tumor and liver metastasis resected;2)A group of 57 cases with simple primary tumor resection and unresectable liver metastasis;3)41 cases in the group with neither primary tumor nor liver metastasis resected.1.There were no significant differences in OS and PFS between patients with CRLM that were initially resectable and those who successfully transformed with conversion therapy(P>0.05).2.The median OS was 36 months in the group with successful conversion,compared with 21 months in the group with simple primary tumor resection and no resected liver metastasis(P=0.014),and HR=0.48(0.27 –0.86);The median PFS was 28 months in the successful conversion group compared with 10 months in the primary tumor resection-only and unresectable liver metastases group(P=0.005),and HR=0.43(0.24 – 0.77).3.OS difference between simple primary tumor resection group with no resected liver metastasis and primary tumor and no resected liver metastasis group is statistically significant: 21 months VS13months(P=0.01),HR=0.52(0.32 – 0.86);There was no significant difference between PFS groups(P>0.05).(2)The success rate of conversion and short-term efficacy are also different with different conversion treatment options: 1.A total of 30 cases were successfully transformed(12 cases in the chemotherapy alone group,16 cases in the chemotherapy+targeted group and 2 cases in the chemotherapy+local treatment group);2.Chemotherapy alone(based on oxaliplatin and irinotecan)was applied in 1case of CR,22 cases of PR,27 cases of SD and 11 cases of PD;The ORR(objective response rate)and DCR(disease control rate)were 37.1% and 82.2%,respectively,and the conversion success rate was 19.7%.3.Chemotherapy+targeted therapy(bevacizumab or cetuximab): CR2 cases,PR28 cases,SD18 cases,PD4 cases.The ORR(objective response rate)was 57.7%,DCR(disease control rate)was 92.3%,and the conversion success rate was 30.8%.4.Chemotherapy+local treatment(radio frequency or HAIC,etc.): 1 case in CR,4 cases in PR,6 cases in SD,and 4 cases in PD.The ORR(objective remission rate)is 35.7%,DCR(disease control rate)is73.3%,and the conversion success rate is 13.3%.(3)The efficacy was assessed as CR+PR being the key factor for successful transformation in patients with colorectal cancer with simultaneous unresectable hepatic metastasis.(4)univariate analysis showed that the location of the primary tumor,whether the primary tumor was resected,the number of CA199,the largest diameter of liver metastases,and the conversion efficacy were the factors affecting OS in patients with liver metastasis from colorectal cancer.(5)Multi-factor analysis shows that the location of the primary tumor,the number of CA199,the largest diameter of liver metastases and the efficacy of conversion are the independent risk factors affecting the prognosis of patients.(6)During the conversion treatment,patients would have adverse reactions,but the majority of adverse reactions were grade 1 – 2,which would not cause life-threatening to patients.In addition,there were four perioperative complications in patients with successful conversion.Two cases of bleeding(all using bevacizumab),one case of anastomotic leakage and one case of gastroparesis were all discharged successfully after treatment.(7)nomogram C-index=0.714Conclusion: 1.The key factor for the success of conversion therapy is to select a conversion protocol with higher ORR,and the chemotherapy plus targeted therapy has the best effect,thus improving the R0 surgical resection rate and survival rate of patients;It is recommended that all patients with colorectal cancer with unresectable hepatic metastases should undergo conversion therapy as soon as possible.2.Even if the conversion treatment is unsuccessful,only the primary tumor resection can improve the prognosis of these patients to a certain extent.3.The location of the tumor,whether the primary lesion was resected,the number of CA199,the maximum diameter of the liver metastases,and the conversion efficacy are factors that affect OS in patients with liver metastases from colorectal cancer.4.The prediction model established based on the prognostic factors can better judge the prognosis of patients with colorectal cancer with simultaneous unresectable liver metastasis. |
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