コテラ　ヨシヒト   KOTERA Yoshihito   小寺　由人    所属   医学部 医学科（東京女子医科大学病院）    職種   非常勤講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Survival Benefit of and Indications for Adjuvant Chemotherapy for Resected Colorectal Liver Metastases-a Japanese Nationwide Survey.
掲載誌名	正式名：Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 略　 称：J Gastrointest Surg ISSNコード：18734626/1091255X
巻・号・頁	24(6),pp.1244-1260
著者・共著者	Kobayashi Shin, Beppu Toru, Honda Goro, Yamamoto Masakazu, Takahashi Keiichi, Endo Itaru, Hasegawa Kiyoshi, Kotake Kenjiro, Itabashi Michio, Hashiguchi Yojiro, Kotera Yoshihito, Sakamoto Katsunori, Yamaguchi Tatsuro, Morita Satoshi, Tabuchi Ken, Miyazaki Masaru, Sugihara Kenichi
発行年月	2020/06
概要	BACKGROUND:The survival benefit of and indications for adjuvant chemotherapy (AC) for colorectal liver metastases (CRLM) remain unclear.METHODS:Patients who were diagnosed with liver-limited CRLM between 2005 and 2007 and subsequently underwent R0 resection without preoperative chemotherapy were identified in a Japanese nationwide survey. This overall cohort was divided into synchronous and metachronous CRLM cohorts. In each of the three cohorts, the patients that were given AC were matched with those treated with surgery alone via 1:1 propensity score (PS) matching. Recurrence-free survival (RFS) and overall survival (OS) after the initial hepatectomy were compared.RESULTS:The median follow-up period was 79.4 months and the overall, synchronous, and metachronous cohorts included 1145, 498, and 647 patients, respectively. After the PS matching, the patients' demographics were well balanced. AC was effective in terms of both RFS and OS in the overall cohort (RFS hazard ratio [HR] 0.784, p = 0.045; OS HR 0.716, p = 0.028) and synchronous cohort (RFS HR 0.677, p = 0.027; OS HR 0.642, p = 0.036), whereas AC was not effective in the metachronous cohort (RFS HR 0.875, p = 0.378; OS HR 0.881, p = 0.496). However, in the metachronous cohort, AC was effective in terms of OS in the subgroup that exhibited disease-free intervals of ≤ 1 year after primary tumor resection (RFS HR 0.667, p = 0.068; OS HR 0.572, p = 0.042).CONCLUSION:Adjuvant chemotherapy has a survival benefit for patients with resected CRLM. Synchronous CRLM is a favorable indication for AC, whereas in metachronous CRLM, the use of AC should be individualized according to each patient's risk factors.
DOI	10.1007/s11605-019-04250-9
PMID	31197683