廣 純一郎

OBJECTIVE: The risk factors for residual liver recurrence after resection of colorectal cancer liver metastases were analyzed separately for synchronous and metachronous metastases. METHODS: This retrospective study included 236 patients (139 with synchronous and 97 with metachronous lesions) who underwent initial surgery for colorectal cancer liver metastases from April 2010 to December 2021 at the Fujita Health University Hospital. We performed univariate and multivariate analyses of risk factors for recurrence based on clinical background. RESULTS: Univariate analysis of synchronous liver metastases identified three risk factors: positive lymph nodes (p = 0.018, HR = 2.067), ≥3 liver metastases (p < 0.001, HR = 2.382), and use of adjuvant chemotherapy (p = 0.013, HR = 0.560). Multivariate analysis identified the same three factors. For metachronous liver metastases, univariate and multivariate analysis identified ≥3 liver metastases as a risk factor (p = 0.002, HR = 2.988); however, use of adjuvant chemotherapy after hepatic resection was not associated with a lower risk of recurrence for metachronous lesions. Inverse probability of treatment weighting analysis of patients with these lesions with or without adjuvant chemotherapy after primary resection showed that patients with metachronous liver metastases who did not receive this treatment had fewer recurrences when adjuvant therapy was administered after subsequent liver resection, although the difference was not significant. Patients who received adjuvant chemotherapy after hepatic resection had less recurrence but less benefit from this treatment. CONCLUSION: Risk factors for liver recurrence after resection of synchronous liver metastases were positive lymph nodes, ≥3 liver metastases, and no postoperative adjuvant chemotherapy. Adjuvant chemotherapy is recommended after hepatic resection of synchronous liver metastases.

47歳女性,血便精査の大腸内視鏡検査でS状結腸に粘膜下腫瘤(submucosal tumor:SMT)様隆起に連なる潰瘍病変を認め,HE染色で低分化腺癌と診断された.画像上,S状結腸以外にも骨盤内に多数腫瘤を認め,腫瘍マーカーはCA125が高値であった.免疫染色でCK7(+),CK20(-),Pax-8(+)と判明し,婦人科癌の転移と診断した.審査腹腔鏡を行い,卵巣に異常を伴わない腹膜播種の所見であったため,腹膜癌(高異型度漿液性腺癌)と診断した.化学療法3コース後にdebulking surgeryを実施したところ,卵巣に同様の腺癌を認め,卵巣癌の診断に至った.骨盤内腫瘤を伴う大腸腫瘍では免疫染色を考慮することが有用である.(著者抄録)