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01-02-2019 | Hepatobiliary Tumors

Higher Tumor Burden Neutralizes Negative Margin Status in Hepatectomy for Colorectal Cancer Liver Metastasis

Authors: Masanori Oshi, MD, Georgios Antonios Margonis, MD, PhD, Yu Sawada, MD, PhD, Nikolaos Andreatos, MD, Jin He, MD, PhD, Takafumi Kumamoto, MD, PhD, Daisuke Morioka, MD, PhD, Christopher Lee Wolfgang, MD, PhD, Kuniya Tanaka, MD, PhD, Matthew John Weiss, MD, Itaru Endo, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2019

Abstract

Objective

The aim of this study was to examine if the prognostic significance of margin status in hepatectomy for colorectal cancer liver metastasis (CRLM) varies for different levels of tumor burden because hepatectomy indications for CRLM have been recently expanded to include patients with a higher tumor burden in whom achieving an R0 resection is difficult.

Methods

Clinicopathological variables in an exploration cohort of 290 patients receiving hepatectomy in Japan for CRLM were investigated. R0 resection was defined as a margin width > 0 mm. Tumor burden was assessed using the recently introduced Tumor Burden Score (TBS), which was calculated as TBS² = (maximum tumor diameter in cm)² + (number of lesions)². The principal findings were validated using a cohort from the United States.

Results

R1 resection rates significantly increased as TBS increased: 4/86 (4.7%) in patients with TBS < 3, 29/171 (17.0%) in patients with TBS ≥ 3 and < 9, and 9/33 (27.3%) in patients with TBS ≥ 9 (p < 0.001). R0 resection was significantly superior to R1 resection in patients with TBS ≥ 5; however, this was not the case for TBS ≥ 6, as confirmed by both univariate and multivariate analyses. Furthermore, prehepatectomy chemotherapy was associated with significantly improved survival for patients with TBS ≥ 8. Analysis of the validation cohort yielded similar results.

Conclusions

R0 resection appeared to have a positive impact on prognosis among patients with low tumor burden; however, this was not the case for patients with high tumor burden. As such, systemic treatment, in addition to surgery, may be central to achieving satisfactory outcomes in the latter patient population.

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Title: Higher Tumor Burden Neutralizes Negative Margin Status in Hepatectomy for Colorectal Cancer Liver Metastasis
Authors: Masanori Oshi, MD
Georgios Antonios Margonis, MD, PhD
Yu Sawada, MD, PhD
Nikolaos Andreatos, MD
Jin He, MD, PhD
Takafumi Kumamoto, MD, PhD
Daisuke Morioka, MD, PhD
Christopher Lee Wolfgang, MD, PhD
Kuniya Tanaka, MD, PhD
Matthew John Weiss, MD
Itaru Endo, MD, PhD
Publication date: 01-02-2019
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 2/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6830-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Higher Tumor Burden Neutralizes Negative Margin Status in Hepatectomy for Colorectal Cancer Liver Metastasis

Abstract

Objective

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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