Hepatic Arterial Infusion after Liver Resection
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《新英格兰医药杂志》
To the Editor: In 1999, we reported on the results of a randomized study of adjuvant therapy after liver resection for metastatic colorectal cancer.1 One group of patients was treated with hepatic arterial infusion with floxuridine and dexamethasone plus systemic fluorouracil, with or without leucovorin (combined therapy). The other group received systemic therapy alone, consisting of fluorouracil with or without leucovorin (monotherapy). We reported an increase in two-year survival for the combined-therapy group as compared with the group receiving monotherapy. We also reported a significant increase in the rate of survival free of hepatic progression in the combined-therapy group. All patients have now been followed for a minimum of 6 years, with a median follow-up of 10.3 years. Overall progression-free survival is now significantly greater in the combined-therapy group than in the monotherapy group (31.3 vs. 17.2 months, P=0.02). The median survival free of hepatic progression has not yet been reached in the combined-therapy group, whereas it has reached 32.5 months in the monotherapy group (P<0.01). Median overall survival is now 68.4 months (95 percent confidence interval, 55.2 to not reached) in the group receiving combined therapy and 58.8 months (95 percent confidence interval, 42.0 to 85.2) in the monotherapy group (P=0.10). Ten-year survival rates are 41.1 percent and 27.2 percent, respectively (Figure 1). Toxicity since our first report includes late biliary toxic effects in two additional patients.
Figure 1. Overall Survival among Patients with Metastatic Colorectal Cancer Who Were Treated with Hepatic Arterial Infusion plus Systemic Chemotherapy (Combined Therapy) or with Systemic Chemotherapy Alone (Monotherapy).
When patients were stratified with the use of a clinical-risk scoring system2 that predicts the outcome after hepatic resection, those with a score of 0 to 2 had a similar median survival (83.3 months for the combined-therapy group and 82.8 months for the monotherapy group). By contrast, patients with a high risk of recurrence (a score of 3 to 5) had a median survival of 60.0 months in the combined-therapy group and 38.3 months in the monotherapy group (P=0.13) and a 10-year survival rate of 38.7 percent in the combined-therapy group and 16.3 percent in the monotherapy group. Although the study was not powered for five-year survival, there was improved progression-free survival and survival free of hepatic progression, and a trend toward an improved long-term outcome in the group receiving combined therapy, with a survival rate of approximately 40 percent at 10 years, even among patients with the greatest risk of recurrence.
Nancy E. Kemeny, M.D.
Mithat Gonen, Ph.D.
Memorial Sloan-Kettering Cancer Center
New York, NY 10021
References
Kemeny N, Huang Y, Cohen AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 1999;341:2039-2048.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309-321.
Figure 1. Overall Survival among Patients with Metastatic Colorectal Cancer Who Were Treated with Hepatic Arterial Infusion plus Systemic Chemotherapy (Combined Therapy) or with Systemic Chemotherapy Alone (Monotherapy).
When patients were stratified with the use of a clinical-risk scoring system2 that predicts the outcome after hepatic resection, those with a score of 0 to 2 had a similar median survival (83.3 months for the combined-therapy group and 82.8 months for the monotherapy group). By contrast, patients with a high risk of recurrence (a score of 3 to 5) had a median survival of 60.0 months in the combined-therapy group and 38.3 months in the monotherapy group (P=0.13) and a 10-year survival rate of 38.7 percent in the combined-therapy group and 16.3 percent in the monotherapy group. Although the study was not powered for five-year survival, there was improved progression-free survival and survival free of hepatic progression, and a trend toward an improved long-term outcome in the group receiving combined therapy, with a survival rate of approximately 40 percent at 10 years, even among patients with the greatest risk of recurrence.
Nancy E. Kemeny, M.D.
Mithat Gonen, Ph.D.
Memorial Sloan-Kettering Cancer Center
New York, NY 10021
References
Kemeny N, Huang Y, Cohen AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 1999;341:2039-2048.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309-321.