23-10-2024 | Metastasis | ASO Author Reflections
ASO Author Reflections: Biological Contraindications to Surgery in Colorectal Liver Metastasis
Authors:
Kazunari Sasaki, MD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon), Georgios Antonios Margonis, MD, PhD
Published in:
Annals of Surgical Oncology
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Excerpt
The resectability of colorectal liver metastases (CRLM) is typically categorized as ‘resectable’, ‘borderline’, or ‘unresectable’. The proportion of cases classified as ‘unresectable’ has decreased over the years, as resectable disease is now defined as any tumor burden, provided the liver remnant is sufficient to maintain adequate liver function. Conversely, the proportion of cases deemed ‘borderline’ has increased, as certain patient- and tumor-related characteristics that previously defined ‘unresectable’ cases (e.g., extrahepatic disease or tumor number) are now used to classify ‘borderline’ disease. The rationale is that these characteristics reflect aggressive tumor biology, and the combinations of these factors have been employed to devise clinical risk scores, such as the Fong score, aimed at guiding resectability decisions. As early as 1999, Fong and colleagues noted that information on tumor biology “may further stratify patients with regard to outcome”, provided “it becomes routinely available beyond a few academic centers”.
1 Over the last decade, RAS mutations, and to a lesser extent BRAF mutations, have been commonly tested for clinical purposes. These mutations, along with clinicopathologic variables, have been used to develop clinico-biological risk scores that hold promise to identify ‘biological contraindications’ for CRLM resection. However, to our knowledge, these proposed ‘biological contraindications’ have not been validated outside the cohorts/studies used to devise them, leaving it unclear whether they can be applied in clinical practice. …