| Research BackgroundColorectal cancer(CRC)is the third most common cancer in the world and the fourth most common cause of cancer death.The number of colorectal cancer cases worldwide in 2019 was 1.87 million,and the death toll was approximately 880.000.According to epidemiological surveys,the incidence of colorectal cancer in China ranks fourth among all types of malignant tumors,and the annual mortality rate ranks fifth.The liver is the most important organ for colorectal cancer blood metastasis.About 15%-25%of patients have liver metastases at the time of first diagnosis,and another 15%-25%of patients will have metachronism after radical surgery of the primary foci Liver metastasis.Colorectal cancer liver metastasis is also the main cause of death in colorectal cancer patients.The median survival time of patients with untreated liver metastases is only 6.9 months,and the 5-year survival rate of patients with unresectable liver metastases is close to 0%.The median survival time of patients with metastases that can be completely removed is 35 months,and the 5-year survival rate can reach 30%to 50%.Hellman and Weichselbaum jointly proposed the concept of "oligometastases" in the 1990s.In 2016,the European Society of Medical Oncology(ESMO)first proposed the concept of "oligometastasis" in the diagnosis and treatment of colorectal cancer,and divided advanced colorectal cancer into two categories:"diffuse disease" and "oligometastatic disease",and proposed treatment The key point is to pay more attention to the local treatment of metastases based on the effectiveness of systemic treatment,and emphasize the importance of "local damage treatment"(LAT)in the treatment of oligometastasis.When the simultaneous liver metastasis of colorectal cancer is determined to be oligometastasis,surgery is the main treatment for this group of patients.However,through clinical observation,it was found that some patients with simultaneous colorectal cancer liver metastases developed explosive liver metastases within a short period of time after surgery.Because there are few relevant studies on the explosive progress of simultaneous colorectal cancer liver metastasis after surgery,and a systematic and comprehensive analysis is still lacking,this study retrospectively analyzed the clinicopathological characteristics of 129 patients with simultaneous colorectal cancer liver metastases undergoing surgery And prognosis,to explore the influencing factors of the postoperative explosive progress,so as to provide a basis for the treatment of simultaneous colorectal cancer liver metastasis.Research methodsCollected relevant data of 129 patients with liver metastases from colorectal cancer who underwent surgical treatment at Qilu Hospital of Shandong University from January 1,2010 to December 31,2015.The clinical and pathological data and survival status were analyzed retrospectively.The deadline for follow-up is January 31,2020.The clinical and pathological data collected from patients include:1.Basic information:name,gender,and age.2.Hematological results one week before surgery and within one month after surgery,three months after surgery,and six months after surgery:CEA,CA-199,alanine aminotransferase,aspartate aminotransferase,neutrophil count,lymphocyte count,granulocyte/Lymphocyte ratio.3.Pathological data:histological classification,degree of pathological differentiation,tumor location,pathological type,lesion size,depth of invasion,number of lymph nodes in the outbreak group,tumor area,location,number and maximum diameter of liver metastases.4.Other information:Clinical Risk Score(Clinical Risk Score,CRS),genetic test results,ECOG score,Body Mass Index(BMI),and progression-free survival and overall survival of patients.Outbreak group(outbreak progress group after simultaneous colorectal cancer liver metastasis):meet the definition of simultaneous colorectal cancer liver metastasis,the time of occurrence of liver metastasis is no more than 3 months from the time of diagnosis of colorectal cancer,and it is accepted Within 1 month after the operation,the diameter of liver metastasis increased more than 1 times.Non-burst group(non-burst progression group after simultaneous colorectal cancer liver metastasis):meets the definition of simultaneous colorectal cancer liver metastasis,the time of occurrence of liver metastases is not more than 3 months from the time of diagnosis of colorectal cancer Liver metastases increased in diameter by more than 1 fold from 1 month to 3 months after surgery or did not show changes in liver metastases after surgery.Independent samples t test and mean analysis method were used to analyze continuous variables,and Fisher’s exact test or Pearson’s test were used to analyze categorical variables.The Kaplan-Meier survival analysis method was used to analyze the PFS and OS of patients.The univariate and multivariate analysis of patient survival was analyzed using the COX risk proportional regression model.All of the above data analysis uses SAS 9.4 statistical software.A two-tailed p-value was used in the study,p<0.05 was considered statistically significant.Research result1.A total of 129 cases of patients with concurrent colorectal cancer liver metastases were included in this study.The median PFS was 9.5 months and the median OS was 20 months.The PFS and OS of the patient were related to the number of liver metastases,vascular infiltration and CRS score(all P<0.05).With the increase of the number of liver metastases,the PFS and OS of the patient decreased;compared with patients with vascular infiltration PFS and OS decreased in patients without vascular infiltration;as CRS score increased,PFS and OS decreased.2.Univariate analysis showed that CRS score,preoperative CA199.postoperative particle/lymph ratio,postoperative ALT,postoperative AST,postoperative CA199,vascular infiltration,and the number of liver metastases were related to the patient’s explosive postoperative progression.Multivariate analysis showed that for each postoperative increase in the granulocyte-to-lymph ratio by 1,the patient’s risk of explosive postoperative progression may decrease by approximately 44%.Compared with patients with vascular infiltration,patients without vascular infiltration may have a 74%reduction in postoperative explosive progression.Patients with 3 or more liver metastases may be 3.29 times more likely to have operative progression after surgery than patients with 1 liver metastasis.3.Single factor analysis showed that PFS,postoperative ALT,postoperative AST,and vascular infiltration were related to the patient’s overall survival,and the difference was statistically significant.The significant factors found by single factor analysis:PFS,postoperative ALT,postoperative AST,and vascular infiltration were included in the COX proportional hazard regression model for stepwise regression analysis.The results showed that PFS,postoperative AST,and vascular infiltration were the total Factors affecting survival.Every month the PFS increases,the patient’s risk of disease progression decreases by 3%(HR=0.976,95%CI:0.955-0.997).Compared with patients with vascular infiltration,the overall survival of patients without vascular infiltration will increase by 54%Analysis conclusion1.Patients with concurrent colorectal cancer liver metastases with greater than or equal to 3 postoperative particle/lymph ratio reduction,vascular infiltration,or liver metastases are more likely to have explosive postoperative progression.2.OS and PFS in patients with simultaneous colorectal cancer liver metastasis are negatively correlated with the number of liver metastases,vascular invasion and CRS score.3.PFS significantly decreased in patients with postoperative granular/lymph ratio,vascular infiltration or liver metastases greater than or equal to 3;patients with PFS shortened or vascular infiltration significantly shortened OS. |
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