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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2012

01-09-2012 | Colorectal Cancer

Pathologic Response to Preoperative Chemotherapy in Colorectal Liver Metastases: Fibrosis, not Necrosis, Predicts Outcome

Authors: George A. Poultsides, MD, MS, Fei Bao, MD, Elliot L. Servais, MD, Tina Hernandez-Boussard, PhD, Ronald P. DeMatteo, MD, Peter J. Allen, MD, Yuman Fong, MD, Nancy E. Kemeny, MD, Leonard B. Saltz, MD, David S. Klimstra, MD, William R. Jarnagin, MD, Jinru Shia, MD, Michael I. D’Angelica, MD

Published in: Annals of Surgical Oncology | Issue 9/2012

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Abstract

Background

Pathologic response to preoperative chemotherapy for colorectal liver metastases (CLM) is associated with survival after hepatectomy. Histologically, dominant response patterns include fibrosis, necrosis and/or acellular mucin, but some of these changes can appear without previous chemotherapy and their individual correlation with outcome is unknown.

Methods

Pathology slides from patients who underwent CLM resection (irrespective of preoperative chemotherapy status) were rereviewed by a blinded pathologist. Pathologic response was recorded as the summation of percentage necrosis, fibrosis and acellular mucin. Associations between pathologic response, its components, preoperative chemotherapy, and survival were analyzed.

Results

Pathology slides were rereviewed in 366 patients undergoing CLM resection from 2003 to 2007. Preoperative chemotherapy was administered in 249 (68 %) patients, who, when compared to no preoperative chemotherapy patients, had higher rates of overall pathologic response (57 vs. 46 %, P < .01), fibrosis (21 vs. 12 %, P < .01) and acellular mucin (6 vs. 3 %, P = .05) but similar rates of necrosis (30 vs. 31 %, P = .30). In patients receiving preoperative chemotherapy, overall pathologic response ≥75 % (5 year, 83 vs. 47 %, P < .01) and fibrosis ≥40 % (5 year, 87 vs. 51 %, P < .01) independently correlated with disease-specific survival after hepatectomy. Preoperative hepatic artery infusion chemotherapy (P = .04) and bevacizumab (P = .05) were marginally associated with overall pathologic response and fibrosis, respectively.

Conclusions

Fibrosis is the predominant chemotherapy-related pathologic alteration driving the association of treatment response with survival after CLM resection. Necrosis in CLM is not related to chemotherapy or outcome.
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Metadata
Title
Pathologic Response to Preoperative Chemotherapy in Colorectal Liver Metastases: Fibrosis, not Necrosis, Predicts Outcome
Authors
George A. Poultsides, MD, MS
Fei Bao, MD
Elliot L. Servais, MD
Tina Hernandez-Boussard, PhD
Ronald P. DeMatteo, MD
Peter J. Allen, MD
Yuman Fong, MD
Nancy E. Kemeny, MD
Leonard B. Saltz, MD
David S. Klimstra, MD
William R. Jarnagin, MD
Jinru Shia, MD
Michael I. D’Angelica, MD
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 9/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2335-1

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