Hepatectomy Versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression After Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Feb 11

PMID 36765743

Authors

Simone Famularo

Flavio Milana

Matteo Cimino

Fabio Procopio

Guido Costa

Jacopo Galvanin

Elisa Paoluzzi Tomada

Francesca Margherita Bunino

Angela Palmisano

Matteo Donadon

Guido Torzilli

Affiliations

Soon will be listed here.

Abstract

Disease progression (PD) at neoadjuvant chemotherapy for patients with colorectal liver metastases (CLMs) is considered a contraindication to hepatic resection. Our aim was to estimate the overall survival (OS) in patients undergoing surgery compared with those treated exclusively with chemotherapy in cases of PD. Patients from a single centre with PD were analyzed and subdivided into two groups: hepatectomy (HEP) versus chemotherapy (CHT). An Inverse Probability Weighting (IPW) was run to balance the baseline differences between the two groups. A Cox regression was carried out on identifying factors predicting mortality. From 2010 to 2020, 105 patients in PD to at least one line of chemotherapy were analyzed. Of these, 27 (25.7%) underwent hepatic resection. After a median follow-up of 30 (IQR 14-46) months, 61.9% were dead. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 95 and 46.8% for HEP ( < 0.001). After IPW, two balanced pseudopopulations were obtained: HEP = 85 and CHT = 103. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 97.8 and 49.3% for HEP (HR 0.256, 95%CI: 0.08-0.78, = 0.033). After IPW, in the multivariate model, surgery resulted in the only protective variable (HR 0.198, 95%CI: 0.08-0.48, = 0.0016). Our results show that hepatic resection could offer a chance of a longer OS than the prosecution of chemotherapy only in originally resectable patients.

Citing Articles

Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis.

Cheng X, Zhao F, Chen D, Liu F World J Gastroenterol. 2024; 30(7):663-672.

PMID: 38515943 PMC: 10950626. DOI: 10.3748/wjg.v30.i7.663.

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