What is the Prognostic Value of a Discordant Radiologic and Pathologic Response in Patients Undergoing Resection of Colorectal Liver Metastases After Preoperative Chemotherapy?

被引：21

作者：

Brouquet, Antoine ^{[1
,2
]}

Blot, Christelle ^{[1
,2
]}

Allard, Marc-Antoine ^{[2
,3
]}

Lazure, Thierry ^{[4
]}

Sebbagh, Mylene ^{[2
,4
]}

Gayet, Mathilde ^{[5
]}

Lewin, Maite ^{[2
,6
]}

Adam, Rene ^{[2
,3
]}

Penna, Christophe ^{[1
,2
]}

Sa Cunha, Antonio ^{[2
,3
]}

Benoist, Stephane ^{[1
,2
]}

机构：

[1] Univ Paris Sud, Bicetre Hosp, AP HP, Dept Digest Surg & Surg Oncol, Le Kremlin Bicetre, France

[2] Paris Sud Univ, Le Kremlin Bicetre, France

[3] Hop Paul Brousse, Dept Hepatobiliary & Pancreat Surg & Liver Transp, Villejuif, France

[4] Paris Sud Univ, Bicetre Hosp, AP HP, Dept Pathol, Le Kremlin Bicetre, France

[5] Paris Sud Univ, Bicetre Hosp, AP HP, Dept Radiol, Le Kremlin Bicetre, France

[6] Paris Sud Univ, Paul Brousse Hosp, AP HP, Dept Radiol, Le Kremlin Bicetre, France

来源：

ANNALS OF SURGICAL ONCOLOGY | 2020年 / 27卷 / 08期

关键词：

NEOADJUVANT CHEMOTHERAPY; CONTRAINDICATION; BEVACIZUMAB; PROGRESSION; SURVIVAL; SURGERY;

D O I：

10.1245/s10434-020-08284-1

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background The clinical significance of discordant radiological and pathological response to preoperative chemotherapy of colorectal liver metastases (CLM) is unknown. Methods From 2011 to 2016, all eligible patients undergoing resection for CLM after preoperative chemotherapy were included at two centres. Patients were categorized according to radiologic response using RECIST as Rad-responders (complete/partial response) or Rad-non responders (stable disease) and according to Blazer et al. pathologic response grade as Path-responders (complete/major response) or Path-non responders (minor response). Survival outcome was analysed according to radiologic and pathologic response. Results Among 413 patients undergoing resection of CLM, 119 fulfilled the inclusion criteria. Among these, 52 (44%) had discordant radiologic and pathologic response including 27 Rad-non responders/path responders and 25 Rad-responders/Path-non responders. Rad-non responders/path responders and Rad-responders/Path-non responders had similar characteristics except for the proportion receiving more than 6 cycles of preoperative chemotherapy (7/27 vs 16/25; P = 0.017). Median disease-free survival was not different in patients with or without discordant radiologic and pathologic responses (P = 0.195) but the type of discordance had an impact on oncologic outcome as median disease-free survival was 13.9 months (95% CI 5.7-22.2 months) in Rad-non responders/Path responders and 8.6 (6.2 - 10.9 months) in Rad-responders/Path-non responders (P = 0.034). Univariate and multivariate analysis showed that major pathologic response was associated with improved disease-free survival (OR 0.583, 95% CI 0.36-0.95, P = 0.031). Conclusion A discordant radiologic and pathologic response is common after preoperative chemotherapy for CLM. In these patients, pathologic response drives oncologic outcome.

引用

页码：2877 / 2885

页数：9

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