Clinical Study On Conversion Therapy In Potentially Resectable Liver Metastasis From Colorectal Cancer

Objective: This study aims to explore the relevant factors affecting the outcome of conversion therapy and prognosis of potentially resectable patients with colorectal cancer that have liver metastasis.Method: The clinical data of patients with potentially resectable liver metastasis from colorectal cancer in the First Affiliated Hospital of Yangtze University from January 2015 to January 2019 were retrospectively analyzed.To investigate the influence of the location of primary tumor,T stage,N stage,time of liver metastasis,size of metastasis,number of metastasis,mode of conversion therapy,short-term efficacy of conversion therapy,resection of primary tumor and liver metastasis on the outcome of conversion therapy and Overall Survival.Using the IBM SPSS25.0 software,Kaplan-Meier method was used to draw the survival curve,and log-rank test was performed for survival analysis and univariate analysis.Multivariate COX proportional hazards model was applied to multivariate analysis.Chisquare test was used for correlation analysis of classified variables.P<0.05 was considered as significant difference.Result: 1.A total of 81 patients with potentially resectable colorectal cancer with liver metastasis were included in this study.Univariate analysis showed that T stage and lymph node stage of primary tumor,number of liver metastases,maximum diameter of liver metastases,CRS score,mode of conversion therapy,local treatment,short-term efficacy of conversion therapy,resection of primary tumor and liver metastases were risk factors for Overall Survival.However,gender,age,primary site of tumor,time of metastasis and chemotherapy cycle had no significant effect on OS2.Multivariate analysis showed that mode of conversion therapy,duration of conversion therapy,short-term efficacy of conversion,whether the primary lesion and liver metastasis were resected were independent prognostic factors for potentially resectable colorectal cancer with liver metastasis.3.Effectiveness and success rate of different conversion therapy modality: Among the included 81 patients,22 patients received CAPEOX regimen,10 patients(45.5%)achieved PR,3 patients(13.6%)achieved SD,9 patients(40.9%)achieved PD,the objective response rate ORR was 45.5%,the disease control rate DCR was 59.1%,and the conversion success rate was 22.7%.The CAPEOX+ bevacizumab regimen was applied in 13 patients.There were 7 cases(53.4%)of PR,1 case(7.7%)of SD,5 cases(38.5%)of PD,53.4% of ORR,61.5% of DCR,and 46.1% of successful conversion rate;9 patients received FOLFOX regimen,2 patients achieved PR(22.3%),3 patients achieved SD(33.3%),4 patients achieved PD(44.4%),ORR(22.3%),and DCR(55.6%).Eight patients were treated with FOLFOX+ bevacizumab regimen,with 1 patient rated as CR(12.5%),4 as PR(50%),1 as SD(12.5%),and 2 as PD(25%).FOLFIRI regimen was used in 15 patients,including 5 patients with PR(33.3%),3 patients with SD(20%),7patients with PD(46.7%),ORR(33.3%),DCR(53.3%),and conversion success rate(26.7%).FOLFIRI+ bevacizumab was used in 14 patients,with CR(14.3%)in 2 patients,PR(57.1%)in 8 patients,and PD(28.6%)in 4 patients.ORR and DCR were both 71.4%,and the conversion success rate was 42.3%.Among all the enrolled patients,46 received chemotherapy alone,17 were evaluated as PR(37%),9 as SD(19.6%),20 as PD(43.5%),37% as ORR,56.5% as DCR,and 19.6% as conversion success rate.35 patients were treated with chemotherapy combined with targeted therapy,3 patients were evaluated as CR(8.6%),19 patients as PR(54.3%),2 patients as SD(5.7%),11 patients as PD(31.4%),ORR was 62.9%,DCR was 68.5%,and the conversion success rate was 42.9%.The number of patients with combined local therapy was 14,with CR(2 cases)(14.33%),PR(10 cases)(71.4%),SD(2 cases)(14.3%),ORR(85.7%),DCR(100%)and transformation success rate(57.1%).There were 67 cases without combined local therapy,only 1 case(1.5%)was evaluated as CR,26 cases(38.8%)as PR,9 cases(13.4%)as SD,31 cases(46.3%)as PD,40.3% as ORR,53.7% as DCR,and 23.9% as conversion success rate.4.T stage and N stage of primary tumor,maximum diameter of liver metastases,number of liver metastases,CRS score,mode of conversion therapy,cycle of chemotherapy,short-term efficacy of transformation therapy,and whether local treatment is performed are related factors that affect the outcome of transformation therapy.5.Liver metastases of maximum diameter,CRS score and conversion method are independent risk factors effect the success of the treatment of patients with liver metastases from colorectal cancer(P < 0.05),liver metastases diameter < 5 cm,CRS score1 to 2 points,and adopt the method of chemotherapy with targeted therapy can make the patients gain greater success rate.Conclusion: 1.For patients with potentially resectable CRC liver metastasis,the mode of conversion therapy,the short-term efficacy of conversion therapy,the period of conversion therapy,resection of the primary site,and resection of liver metastasis were independent risk factors affecting the prognosis of patients with potentially resectable CRC liver metastasis.2.T stage and N stage of primary tumor,maximum diameter of liver metastases,number of liver metastases,CRS score,mode of conversion therapy,cycle of chemotherapy,short-term efficacy of transformation therapy,and whether local treatment is performed are the factors that affect the outcome of conversion therapy.3.Patients with low CRS score have a higher probability of successful conversion,and such patients should be treated with aggressive conversion therapy to achieve surgical resection.4.The use of chemotherapy in combination with targeted therapy or in combination with local therapy leads to a greater success rate of transformation and a better survival benefit for patients with potentially resectable CRC liver metastases.