| Objective: To investigate the survival benefits of targeted therapy on Liver metastasis of colorectal cancer CRLM,and analyze the influencing factors on the success of conversion in patients with initially unresectable liver metastases to provides reference for clinicians to develop individualized treatment plan.Methods: In this study,a retrospective case-control study was conducted to collect clinical data of 77 patients who were hospitalized in the Department of General Surgery of the First People’s Hospital of Yunnan Province from January 2017 to January 2022 and met the requirements,who were clearly diagnosed with CRLM and identified as initial unresectable liver metastases after multidisciplinary consultation(MDT),According to whether the transformation was successful or not,the patients were divided into group A: the successful transformation group,that is,the patients underwent surgical resection of liver metastases after first-line systemic treatment,with a total of 25 patients.Group B: conversion failure group,that is,patients who could not be resected after first-line systemic treatment and MDT discussion,a total of 52 patients.Fifty-nine of 77 patients received targeted therapy during conversion,including 18 folfox plus bevacizumab,13 folfox plus cetuximab,13 Cape OX plus bevacizumab,and 7 Cape OX plus cetuximab.Four patients received folfiri plus bevacizumab,and 4 patients received folfiri plus cetuximab.The other 18 patients did not receive combined targeted therapy due to economic or other reasons,and only received systemic chemotherapy alone,of which 14 patients received folfox regimen,3 patients received Cape OX regimen,and 1 patient received folfiri regimen.Results: Twenty-five of the 77 patients included in the study were successfully transformed,including 15 patients who underwent radical radiofrequency liver ablation,7 patients who underwent partial hepatectomy alone,and 3 patients who underwent combined intraoperative radiofrequency liver ablation.The median follow-up time was 18(13.775-22.225)months.By the last follow-up,58 patients had died.The mean survival time of patients who successfully converted was longer than that of patients who failed to convert(34.95 months vs.13.05 months,P<0.001).Survival analysis found that patients treated with targeted agents had a longer median survival than those not treated with targeted agents(19 versus 9 months,P=0.005).Univariate Logistic regression analysis found that The maximum length of metastases >6cm(P=0.018),no targeted drug therapy(P=0.04),bilateral distribution of liver metastases(p<0.001),metastasis of other target organs during transformation(p=0.007),number of metastases >8(p=0.017),and poorly differentiated primary pathologic type(p=0.013)were Risk factors for conversion therapy failure.Multivariate Logistic regression analysis showed that metastasis of other target organs occurred during transformation(OR=64.358,95%CI: 4.854-853.234,P=0.002),and the pathological type of primary lesion was poorly differentiated(OR=8.620,95%CI:1.187-62.605,P=0.033)and bilateral distribution of liver metastases(OR=17.883,95%CI: 2.773-115.344,P=0.02)was an independent risk factor for conversion failure in patients with initially unresectable colorectal cancer liver metastases,and the use of targeted drugs(OR=0.040,95%CI: 0.004-0.365,P=0.004)was an independent protective factor for conversion success.Conclusion:1.Maximum metastasis range diameter >6cm,no targeted drug therapy,bilateral distribution of liver metastases,extrahepatic metastases during transformation,number of metastases >8 and poorly differentiated primary pathologic type were risk factors for transformation therapy failure,extrahepatic metastasis during transformation,poorly differentiated primary pathologic type and bilobal distribution of liver metastasis were independent risk factors for the success of transformation therapy.2.Targeted therapy can significantly prolong the survival of patients with initially unresectable CRLM,and is a key factor affecting the success of conversion. |
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