Ann Surg Treat Res.  2019 Nov;97(5):245-253. 10.4174/astr.2019.97.5.245.

Hepatic resection after neoadjuvant chemotherapy for patients with liver metastases from colorectal cancer: need for cautious planning

Affiliations
  • 1Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ipark@amc.seoul.kr
  • 2Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 5Division of Hepatobiliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 6Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Current neoadjuvant chemotherapy (NAC) may enable therapies such as surgical resection and local ablation of metastases in patients with colorectal liver metastasis (CLM). We evaluated outcomes in CLM patients who underwent resection and/or local treatment after NAC and identified prognostic factors for oncologic outcomes.
METHODS
Patients who received NAC followed by resection and/or local treatment of hepatic metastasis from 2013 to 2015 were included. Treatment and tumor-related variables were tabulated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Cox regression analysis was used to identify factors associated with RFS and OS.
RESULTS
Sixty-eight patients received NAC followed by resection and/or local treatment of hepatic metastases. Targeted therapy was administered in 50% of the patients. RFS was 35.8% at 1 year and 19.4% at 2 years postoperatively. OS was 95.6% at 1 year and 88.2% at 2 years postoperatively. In the multivariable analysis, R1 resection margin (hazard ratio [HR], 3.95; P = 0.008) of the liver metastases and ypN1/ypN2 (HR, 2.356 and 1.983, respectively; P = 0.041) were associated with poor RFS. Both factors were also significantly related to OS.
CONCLUSION
Resection margin of the metastatic tumor and ypN status are the only relevant factors for RFS and OS in CLM patients treated with NAC. Despite early and high rates of recurrence, CLM patients treated with NAC who undergo resection and/or local treatment have acceptable OS. Multidisciplinary review of candidates for surgery and cautious planning are crucial for achieving optimal outcomes.

Keyword

Colorectal cancer; Liver metastases; Neoadjuvant chemotherapy; Survival outcome

MeSH Terms

Colorectal Neoplasms*
Drug Therapy*
Humans
Liver*
Methods
Neoplasm Metastasis*
Recurrence

Figure

  • Fig. 1 Patient selection flowchart.

  • Fig. 2 Kaplan-Meier analysis of survival rates. Recurrence-free survival (A) and overall survival (B) for the 68 patients with colorectal cancer and liver metastasis who received surgical and/or local therapy after neoadjuvant chemotherapy.

  • Fig. 3 Cox proportional hazards model of oncologic outcomes in patients with different resection margin and different ypN status. (A) Recurrence-free survival (RFS) according to resection margin. (B) RFS according to ypN status. (C) Overall survival (OS) according to resection margin. (D) OS according to ypN status.


Cited by  1 articles

Adjuvant oxaliplatin-based chemotherapy effect after treatment of colorectal hepatic metastasis
Mee-Young Kang, Jin-Hee Paik, Chun-Geun Ryu, Dae-Yong Hwang
Ann Surg Treat Res. 2021;101(3):160-166.    doi: 10.4174/astr.2021.101.3.160.


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