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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2018

01-06-2018 | Hepatobiliary Tumors

Progression of Colorectal Liver Metastases from the End of Chemotherapy to Resection: A New Contraindication to Surgery?

Authors: Luca Vigano, MD, PhD, Shadya Sara Darwish, MD, Lorenza Rimassa, MD, Matteo Cimino, MD, Carlo Carnaghi, MD, Matteo Donadon, MD, PhD, Fabio Procopio, MD, Nicola Personeni, MD, Daniele Del Fabbro, MD, Armando Santoro, MD, Guido Torzilli, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 6/2018

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Abstract

Background

Not all patients with resectable colorectal liver metastases (CLM) benefit from liver resection (LR); only patients with disease progression during chemotherapy are excluded from surgery.

Objective

This study was performed to determine whether tumor behavior (stable disease/progression) from the end of chemotherapy to LR impacts prognosis.

Methods

Patients undergoing LR after tumor response or stabilization during chemotherapy were considered. Overall, 128 patients who underwent examination by two imaging modalities (computed tomography/magnetic resonance imaging) after chemotherapy with a > 3-week interval between the two imaging modalities were analyzed. Any variation in CLM size was registered. Tumor progression was defined according to the response evaluation criteria in solid tumors (RECIST) criteria.

Results

Among 128 patients with stable disease or partial response to preoperative chemotherapy, 32 (25%) developed disease progression in the chemotherapy to LR interval, with a disease progression rate of 17% when this interval was < 8 weeks. Survival was lower among patients with progression than those with stable disease [3-year overall survival (OS) 23.0 vs. 52.4%, and recurrence-free survival (RFS) 6.3% vs. 21.6%; p < 0.001]. Survival was extremely poor in patients with early progression (< 8 weeks) (0.0% 2-year OS, 12.5% 6-month RFS). Disease progression in the chemotherapy to LR interval was an independent negative prognostic factor for OS and RFS [hazard ratio 3.144 and 2.350, respectively; p < 0.001].

Conclusions

Early disease progression in the chemotherapy to LR interval occurred in approximately 15% of patients and was associated with extremely poor survival. Even if these data require validation, the risk for early disease progression after chemotherapy should be considered, and, if progression is evident, the indication for surgery should be cautiously evaluated.
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Metadata
Title
Progression of Colorectal Liver Metastases from the End of Chemotherapy to Resection: A New Contraindication to Surgery?
Authors
Luca Vigano, MD, PhD
Shadya Sara Darwish, MD
Lorenza Rimassa, MD
Matteo Cimino, MD
Carlo Carnaghi, MD
Matteo Donadon, MD, PhD
Fabio Procopio, MD
Nicola Personeni, MD
Daniele Del Fabbro, MD
Armando Santoro, MD
Guido Torzilli, MD, PhD, FACS
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6387-8

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