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01-09-2012 | Hepatobiliary Tumors

Progression while Receiving Preoperative Chemotherapy Should Not Be an Absolute Contraindication to Liver Resection for Colorectal Metastases

Authors: Luca Viganò, MD, Lorenzo Capussotti, MD, Eduardo Barroso, MD, Gennaro Nuzzo, MD, Christophe Laurent, MD, Jan N. M. Ijzermans, MD, PhD, Jean-François Gigot, FRCS, Joan Figueras, MD, PhD, Thomas Gruenberger, MD, Darius F. Mirza, FRCS, Dominique Elias, MD, Graeme Poston, FRCS, Christian Letoublon, MD, Helena Isoniemi, MD, Javier Herrera, MD, Francisco Castro Sousa, MD, Fernando Pardo, MD, Valerio Lucidi, MD, Irinel Popescu, MD, PhD, René Adam, MD, PhD

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

Abstract

Purpose

Tumor progression while receiving neoadjuvant chemotherapy (PD) has been associated with poor outcome and is commonly considered a contraindication to liver resection (LR). This study aims to clarify in a large multicenter setting whether PD is always a contraindication to LR.

Methods

Data from the LiverMetSurvey international registry were analyzed. Patients undergoing LR for colorectal metastases without extrahepatic disease after neoadjuvant chemotherapy between 1990 and 2009 were reviewed.

Results

Among 2143 patients, PD occurred in 176 (8.2 %). Risk of progression was increased after 5-FU or irinotecan (22.7 % vs. 6.8 % after other regimens, p < 0.0001; 14.9 % vs. 7.2 %, p < 0.0001), while it was reduced after oxaliplatin (5.6 % vs. 12.0 %, p < 0.0001) and still diminished among patients receiving targeted therapies (2.6 %). PD was an independent prognostic factor of survival at multivariate analysis (35 % vs. 49 %, p = 0.0006). In the PD group, 3 independent prognostic factors were identified: carcinoembryonic antigen (CEA) ≥200 ng/mL (p = 0.003), >3 metastases (p = 0.028), and tumor diameter ≥50 mm (p = 0.002). A survival predictive model showed that patients without any risk factors had 5-year survival rates of 53.3 %; good survival results were still observed if metastases were >3 or ≥50 mm (29.9 and 19.1 %, respectively). On the contrary, survival was less than 10 % at 3 years in the presence of >1 prognostic factor or CEA of ≥200 ng/mL.

Conclusions

PD is a negative prognostic factor, but it is not an absolute contraindication to LR. Patients with PD could be scheduled for LR except for those with >3 metastases and ≥50 mm, or CEA ≥200 ng/mL in whom further chemotherapy is recommended.

Bismuth H, Adam R, Lévi F, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg. 1996;224:509–20.PubMedCrossRef

Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.PubMedCrossRef

Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg. 2006;93:1001–6.PubMedCrossRef

Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.PubMedCrossRef

Allen PJ, Kemeny N, Jarnagin W, DeMatteo R, Blumgart L, Fong Y. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–15.PubMedCrossRef

Tanaka K, Adam R, Shimada H, Azoulay D, Lévi F, Bismuth H. Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg. 2003;90:963–9.PubMedCrossRef

Capussotti L, Vigano’ L, Ferrero A, Lo Tesoriere R, Ribero D, Polastri R. Timing of resection of liver metastases synchronous to colorectal tumor: proposal of prognosis based decisional model. Ann Surg Oncol. 2007;14:1143–50.PubMedCrossRef

Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371(9617):1007–16.PubMedCrossRef

Rubbia-Brandt L, Giostra E, Brezault C, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304.PubMedCrossRef

10.

Adam R, Wicherts DA, de Haas RJ, et al. Complete pathologic response after preoperative chemotherapy for colorectal liver metastases: myth or reality? J Clin Oncol. 2008;26:1635–41.PubMedCrossRef

11.

Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 2006;24:2065–72.PubMedCrossRef

12.

Benoist S, Brouquet A, Penna C, et al. Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol. 2006;24:3939–45.PubMedCrossRef

13.

Gruenberger B, Tamandl D, Schueller J, et al. Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol. 2008;26:1830–5.PubMedCrossRef

14.

Kornprat P, Jarnagin WR, Gonen M, et al. Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol. 2007;14:1151–60.PubMedCrossRef

15.

Neumann UP, Thelen A, Röcken C, et al. Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases. Surgery. 2009;146:52–9.PubMedCrossRef

16.

World Health Organization. Handbook for reporting results of cancer treatment. WHO offset publication no. 48. Geneva: World Health Organization, 1979.

17.

Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRef

18.

Cox DR. Regression models and life tables. J R Stat Soc. 1972;B 34:187–202.

19.

Breslow NE. Covariance analysis of censored survival data. Biometrics. 1974;30:89–99.PubMedCrossRef

20.

Gallagher DJ, Zheng J, Capanu M, et al. Response to neoadjuvant chemotherapy does not predict overall survival for patients with synchronous colorectal hepatic metastases. Ann Surg Oncol. 2009;16:1844–51.PubMedCrossRef

21.

Adam R, Bhangui P, Poston G, et al. Is perioperative chemotherapy useful for solitary, metachronous, colorectal liver metastases? Ann Surg. 2010;252:774–87.PubMedCrossRef

22.

de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250:440–8.PubMed

Title: Progression while Receiving Preoperative Chemotherapy Should Not Be an Absolute Contraindication to Liver Resection for Colorectal Metastases
Authors: Luca Viganò, MD
Lorenzo Capussotti, MD
Eduardo Barroso, MD
Gennaro Nuzzo, MD
Christophe Laurent, MD
Jan N. M. Ijzermans, MD, PhD
Jean-François Gigot, FRCS
Joan Figueras, MD, PhD
Thomas Gruenberger, MD
Darius F. Mirza, FRCS
Dominique Elias, MD
Graeme Poston, FRCS
Christian Letoublon, MD
Helena Isoniemi, MD
Javier Herrera, MD
Francisco Castro Sousa, MD
Fernando Pardo, MD
Valerio Lucidi, MD
Irinel Popescu, MD, PhD
René Adam, MD, PhD
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/s10434-012-2382-7

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Progression while Receiving Preoperative Chemotherapy Should Not Be an Absolute Contraindication to Liver Resection for Colorectal Metastases

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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