The Clinical Observation Of Multiple Sequential Treatments For Colorectal Cancer Patients With Liver Metastases In The Supervisor Mode Of Multidisciplinary

Objective:At present, the single clinical research has confirmed that the patients of colorectal cancer with liver metastasis could benefit from surgical resection, chemotherapy, radiotherapy, interventional therapy.and molecular targeted drugs. But how to integrate these treatment modalities and get them into sequential therapy reasonably, apply to the patients of CRLM, prolong the life expectancy of the patients effectively, are still unclear. Something about has not yet been reported in the literature. The aim of this study is to observe the Clinical curative effect of the multiple sequential therapies in colorectal cancer with liver metastasis under the management of Multidisciplinary Team (MDT).Methods:Basing on the objective performance criteria (OPC), we search the published literatures from the data base before July 2012, search for the 3-year overall survival rate, and take the median level as the target value. From January 1,2012,the patients were hospitalized in the Department of Gastrointestinal Surgery, affiliated Cancer Hospital of Guangxi Medical University, who meet the following criteria, (1) All got electronic colonoscopy examination, and diagnosed as colorectal cancer, the results of CT or MRI was found with liver metastasis. (2) Removal of other parts of the merger except liver, and excluded the combination of other different tumors. (3)Excluded the patients who had received other informal treatments and PS scores >2. (4) each had accepted at least 2 chemotherapy regimens, or 2 different treatments, including surgical resection, chemotherapy, radiotherapy, hepatic artery infusion, microwave ablation or radiofrequency ablation and molecular targeted drugs. (5) Patients with complete clinical data. All patients were assessed by multidisciplinary team (MDT) from the beginning, to discuss and make the best treatment plans, and carry out a variety of sequential therapy. All the patients were followed up, assessed and adjusted the treatment regularly. The deadline of observation was June 30,2015.The overall survival (OS) analysis was calculated by using the Kaplan-Meier method, using SPSS16.0 software. Compared the 1-,2- and 3-years overall survival rate with the target value, and evaluated the clinical effect of multiple sequential therapies according to the results.Results:A total of 55 patients of colorectal with liver metastasis were brought into the observation, and 30 patients were included for twenty-fourth months. Each had accepted at least 2 chemotherapy regimens, or 2 different treatments, between January 1,2012 and June 30,2015 in our department. Primary lesion resection was performed in 34 cases,,9 cases underwent curative resection of liver metastases,6 cases for two-stage resection,3 cases for 1-stage resection; 12 cases only accepted non-operative treatment; hepatic artery infusion chemotherapy in 4 cases, radiofrequency ablation in 8 cases,5 cases had microwave ablation, and molecular targeted drug combined with first-line chemotherapy in 6 cases. During the period of observation, there were 19 patients were died,9 patients received radical treatment, the other 46 patients received non-radical treatment. The mean time of follow-up was 15 months. Thel-,2-and 3-year overall survival rate was 85.4%,68.7% and 47.4% of the 55 patients, respectively. The 46 patients who accepted non-radical treatment, the overall survival rate of 1-,2- and 3-year was 60.3%,38.3% and 38.3%, respectively. According to the search of the literatures, the 3-year overall survival rate of patients with colorectal cancer liver metastases was 37.0%, and the 3-year survival rate of patients of CRLM underwent radical resection was 51.4%.The 3-year overall survival rate of the 55 patients was far larger than the target value 37.0%, and close to the radical treatment overall survival rate 51.4%, the 3-years overall survival rate of non-radical treatment of patients was 38.3%, which was a bit greater than the target value of 37.0%. Therefore, it can be confirmed that multiple sequential therapies may has a certain curative effect on liver metastasis of colorectal cancer.Conclusions:The multiple sequential therapies in the modality of management of multi-disciplinary team, may have a certain effect on the patients of CRLM, increasing the overall survival (OS) of CRLM in a certain extent. A further study is needed of a larger sample and multi-centers of randomized controlled trials to verify the result.