对于未经化疗的无法手术切除的结直肠癌肝转移（CRLM）患者而言，肝动脉灌注（HAI）疗法是最佳的治疗方案。然而，目前的治疗范式已从肝动脉灌注在一线治疗中逐渐漂移开来。因此，我们旨在分析现代时代与HAI疗法（HAI+SYS）结合的一线综合疗法的治疗结果。我们进行了一项回顾性研究，纳入了2003年至2019年间接受HAI+SYS治疗的连续化疗未经治疗的无法手术切除的CRLM患者。患者是从一个前瞻性维护的数据库中筛选出来的。研究结果包括放射学反应率、转为切除率和总生存率。在接受HAI治疗的546名无法手术切除CRLM患者中，确定了58名未经化疗的患者。在诱导治疗后，4名患者（7%）出现了完全的放射学反应，其中两名患者持久反应。总共有32名患者（55%）进行了转为切除手术。在接受7个周期的系统治疗和4个周期的HAI治疗后，患者达到了转为切除手术或完全反应的状态。整个队列的中位生存期为53.0个月（95%置信区间23.0-82.9）。那些转为切除手术或完全反应的患者的3年和5年生存率分别为88%和72%，而未达到转为切除手术或完全反应的患者的3年和5年生存率则分别为27%和0%。在转为切除手术的患者中，有7名患者（22%）获得完全病理反应（即不存在或存活癌细胞比例<10%），有12名患者（38%）获得显著的病理反应。对于未经化疗的患者而言，HAI+SYS的综合治疗方案在大部分患者中均取得了持久且显著的疗效。近三分之二的患者实现了完全反应或转为手术切除，这与长期生存有关。©2023。外科肿瘤学协会。

Chemotherapy-naive patients with unresectable colorectal liver metastases (CRLM) have been the best responders to hepatic arterial infusion (HAI) therapy. The current treatment paradigm has drifted away from HAI in the first-line setting. We aimed to analyze outcomes of combined first-line systemic therapy with HAI therapy (HAI+SYS) in the modern era.We conducted a retrospective study of consecutive chemotherapy-naive patients with unresectable CRLM who received HAI+SYS between 2003 and 2019. Patients were selected from a prospectively maintained database. Outcomes included radiological response rate, conversion to resection (CTR) rate, and overall survival (OS).Fifty-eight chemotherapy-naive patients were identified out of 546 patients with unresectable CRLM managed with HAI. After induction treatment, 4 patients (7%) had a complete radiological response, including two durable responses. In total, 32 patients (55%) underwent CTR. CTR or complete response without resection was achieved after seven cycles of systemic therapy and four cycles of HAI therapy. Median OS for the whole cohort was 53.0 months (95% confidence interval 23.0-82.9). Three- and 5-year OS in patients who achieved CTR or complete response versus patients who did not was 88% and 72% versus 27% and 0% respectively. Of patients who underwent CTR, complete and major pathological response (no and <10% viable tumor cells, respectively) was observed in 7 (22%) and 12 patients (38%).Combined HAI+SYS in chemotherapy-naive patients resulted in durable and substantial response in a large proportion of patients. Nearly two-thirds of patients achieved a complete response or proceeded to conversion surgery, which was associated with prolonged survival.© 2023. Society of Surgical Oncology.