Survival of patients with colorectal liver metastases treated with and without preoperative chemotherapy: Nationwide propensity score-matched study

被引：5

作者：

de Graaff, Michelle. R. ^{[1
,2
]}

Klaase, Joost M. ^{[2
]}

van Dam, Ronald M. ^{[3
]}

Kuhlmann, Koert F. D. ^{[4
]}

Kazemier, Geert ^{[5
]}

Swijnenburg, Rutger-Jan ^{[5
]}

Elfrink, Arthur K. E. ^{[5
]}

Verhoef, Cees ^{[6
]}

Mieog, J. Sven ^{[7
]}

van den Boezem, Peter B. ^{[8
]}

Gobardhan, Paul ^{[9
]}

Rijken, Arjen M. ^{[9
]}

Lips, Daan J. ^{[10
]}

Leclercq, Wouter G. K. ^{[11
]}

Marsman, Hendrik A.

van Duijvendijk, Peter

van der Hoeven, Joost A. B.

Vermas, Marteb ^{[12
]}

den Dulk, Marcel

Grunhagen, Dirk J. ^{[6
]}

Kok, Niels F. M.

机构：

[1] Dutch Inst Clin Auditing, Sci Bur, NL-2333 AA Leiden, Netherlands

[2] Univ Med Ctr Groningen, Dept Surg, Groningen, Netherlands

[3] Maastricht Univ, Med Ctr, Dept Surg, Maastricht, Netherlands

[4] Antoni van Leeuwenhoek Hosp, Dutch Canc Inst, Dept Surg, Amsterdam, Netherlands

[5] Univ Amsterdam, Canc Ctr Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands

[6] Erasmus MC Canc Inst, Dept Surg Oncol, Rotterdam, Netherlands

[7] Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands

[8] Radboud Univ Nijmegen, Dept Surg, Med Ctr, Nijmegen, Netherlands

[9] Radboud Univ Nijmegen, Dept Surg, Med Ctr, Nijmegen, Netherlands

[10] Med Spectrum Twente, Dept Surg, Enschede, Netherlands

[11] Maxima Med Ctr, Dept Surg, Veldhoven, Netherlands

[12] Ijsselland Hosp, Dept Surg, Capelle aan den IJssel, Netherlands

来源：

EJSO | 2023年 / 49卷 / 09期

关键词：

Liver surgery; Colorectal liver metastases; Chemotherapy; Overall survival; Practice variation; NEOADJUVANT CHEMOTHERAPY; SURGERY; RESECTION; TUMOR;

D O I：

10.1016/j.ejso.2023.05.007

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: Routine treatment with preoperative systemic chemotherapy (CTx) in patients with colorectal liver metastases (CRLM) remains controversial due to lack of consistent evidence demonstrating associated survival benefits. This study aimed to determine the effect of preoperative CTx on overall survival (OS) compared to surgery alone and to assess hospital and oncological network variation in 5year OS. Methods: This was a population-based study of all patients who underwent liver resection for CRLM between 2014 and 2017 in the Netherlands. After 1:1 propensity score matching (PSM), OS was compared between patients treated with and without preoperative CTx. Hospital and oncological network variation in 5-year OS corrected for case-mix factors was calculated using an observed/expected ratio. Results: Of 2820 patients included, 852 (30.2%) and 1968 (69.8%) patients were treated with preoperative CTx and surgery alone, respectively. After PSM, 537 patients remained in each group, median number of CRLM; 3 [IQR 2-4], median size of CRLM; 28 mm [IQR 18-44], synchronous CLRM (71.1%). Median follow-up was 80.8 months. Five-year OS rates after PSM for patients treated with and without preoperative chemotherapy were 40.2% versus 38.3% (log-rank P 1/4 0.734). After stratification for low, medium, and high tumour burden based on the tumour burden score (TBS) OS was similar for preoperative chemotherapy vs. surgery alone (log-rank P = 0.486, P = 0.914, and P = 0.744, respectively). After correction for non-modifiable patient and tumour characteristics, no relevant hospital or oncological network variation in five-year OS was observed. Conclusion: In patients eligible for surgical resection, preoperative chemotherapy does not provide an overall survival benefit compared to surgery alone. (c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

引用

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