TY - JOUR
T1 - Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases
AU - Viganò, Luca
AU - Capussotti, Lorenzo
AU - Barroso, Eduardo
AU - Nuzzo, Gennaro
AU - Laurent, Christophe
AU - Ijzermans, Jan N M
AU - Gigot, Jean-François
AU - Figueras, Joan
AU - Gruenberger, Thomas
AU - Mirza, Darius F
AU - Elias, Dominique
AU - Poston, Graeme
AU - Letoublon, Christian
AU - Isoniemi, Helena
AU - Herrera, Javier
AU - Sousa, Francisco Castro
AU - Pardo, Fernando
AU - Lucidi, Valerio
AU - Popescu, Irinel
AU - Adam, René
PY - 2012/9
Y1 - 2012/9
N2 - 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 ≥ 5 0 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.
AB - 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 ≥ 5 0 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.
KW - Aged
KW - Antibodies, Monoclonal
KW - Antibodies, Monoclonal, Humanized
KW - Antineoplastic Combined Chemotherapy Protocols
KW - Bevacizumab
KW - Camptothecin
KW - Carcinoembryonic Antigen
KW - Cetuximab
KW - Colorectal Neoplasms
KW - Disease Progression
KW - Disease-Free Survival
KW - Female
KW - Fluorouracil
KW - Hepatectomy
KW - Humans
KW - Kaplan-Meier Estimate
KW - Liver Neoplasms
KW - Male
KW - Multivariate Analysis
KW - Neoadjuvant Therapy
KW - Organoplatinum Compounds
KW - Proportional Hazards Models
KW - Retrospective Studies
KW - Risk Factors
KW - Survival Rate
KW - Tumor Burden
U2 - 10.1245/s10434-012-2382-7
DO - 10.1245/s10434-012-2382-7
M3 - Article
C2 - 22622469
SN - 1068-9265
VL - 19
SP - 2786
EP - 2796
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 9
ER -