Radiologic and pathologic response to neoadjuvant chemotherapy predicts survival in patients undergoing the liver-first approach for synchronous colorectal liver metastases

被引：21

作者：

Berardi, Giammauro ^{[1
,7
]}

De Man, Marc ^{[2
]}

Laurent, Stephanie ^{[2
]}

Smeets, Peter ^{[3
]}

Tomassini, Federico ^{[1
]}

Ariotti, Riccardo ^{[1
]}

Hoorens, Anne ^{[4
]}

van Dorpe, Jo ^{[4
]}

Varin, Oswald ^{[5
]}

Geboes, Karen ^{[2
]}

Troisi, Roberto I. ^{[1
,6
]}

机构：

[1] Ghent Univ Hosp & Med Sch, Dept Gen Hepatobiliary & Liver Transplantat Surg, C Heymanslaan 10, B-9000 Ghent, Belgium

[2] Ghent Univ Hosp & Med Sch, Dept Oncol, Ghent, Belgium

[3] Ghent Univ Hosp & Med Sch, Dept Radiol, Ghent, Belgium

[4] Ghent Univ Hosp & Med Sch, Dept Pathol, Ghent, Belgium

[5] Ghent Univ Hosp & Med Sch, Dept Gastroenterol, Ghent, Belgium

[6] Univ Naples Federico II, Dept Clin Med & Surg, Naples, Italy

[7] Sapienza Univ Rome, Rome, Italy

来源：

EJSO | 2018年 / 44卷 / 07期

关键词：

Liver first; Oncological outcomes; Radiological response; Tumor regression grade score (TRG); ADVANCED RECTAL-CANCER; LONG-TERM OUTCOMES; HEPATIC RESECTION; ACELLULAR MUCIN; TUMOR-RESPONSE; MANAGEMENT; SURGERY; CARCINOMA; SCORE; OXALIPLATIN;

D O I：

10.1016/j.ejso.2018.03.008

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose: To investigate the short- and long-term outcomes of liver first approach (LFA) in patients with synchronous colorectal liver metastases (CRLM), evaluating the predictive factors of survival. Methods: Sixty-two out of 301 patients presenting with synchronous CRLM underwent LFA between 2007 and 2016. All patients underwent neoadjuvant chemotherapy. After neoadjuvant treatment patients were re-evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST). Liver resection was scheduled after 4-6 weeks. Changes in non-tumoral parenchyma and the tumor response according to the Tumor Regression Grade score (TRG) were assessed on surgical specimens. Primary tumor resection was scheduled 4-8 weeks following hepatectomy. Results: Five patients out of 62 (8.1%) showed "Progressive Disease" at re-evaluation after neoadjuvant chemotherapy, 22 (35.5%) showed "Stable Disease" and 35 (56.5%) "Partial Response"; of these latter, 29 (82%) showed histopathologic downstaging. The 5-year survival (OS) rate was 55%, while the 5-year disease-free survival (DFS) rate was 16%. RECIST criteria, T-stage, N-stage and TRG were independently associated with OS. Bilobar presentation of disease, RECIST criteria, R1 margin and TRG were independently associated with DFS. Patients with response to neoadjuvant chemotherapy had better survival than those with stable or progressive disease (radiological response 5-y OS: 65% vs. 50%; 5-y DFS: 20% vs. 10%; pathological response 5-y OS: 75% vs. 56%; 5-y DFS: 45% vs. 11%). Conclusions: LFA is an oncologically safe strategy. Selection is a critical point, and the best results in terms of OS and DFS are observed in patients having radiological and pathological response to neoadjuvant chemotherapy. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

引用

页码：1069 / 1077

页数：9

共 63 条

[21] Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer - Analysis of 1001 consecutive cases
Fong, Y
Fortner, J
Sun, RL
Brennan, MF
Blumgart, LH
[J]. ANNALS OF SURGERY, 1999, 230 (03) : 309 - 318
[22] Treatment strategies for colorectal carcinoma with synchronous liver metastases: Which way to go?
Ihnat, Peter
Vavra, Petr
Zonca, Pavel
[J]. WORLD JOURNAL OF GASTROENTEROLOGY, 2015, 21 (22) : 7014 - 7021
[23] The Liver-First Approach to the Management of Colorectal Cancer With Synchronous Hepatic Metastases A Systematic Review
Jegatheeswaran, Santhalingam
Mason, James M.
Hancock, Helen C.
Siriwardena, Ajith K.
[J]. JAMA SURGERY, 2013, 148 (04) : 385 - 391
[24] Synchronous Colorectal Liver Metastasis: A Network Meta-Analysis Review Comparing Classical, Combined, and Liver-First Surgical Strategies
Kelly, M. E.
Spolverato, G.
Le, G. N.
Mavros, M. N.
Doyle, F.
Pawlik, T. M.
Winter, D. C.
[J]. JOURNAL OF SURGICAL ONCOLOGY, 2015, 111 (03) : 341 - 351
[25] Design and validation of a histological scoring system for nonalcoholic fatty liver disease
Kleiner, DE
Brunt, EM
Van Natta, M
Behling, C
Contos, MJ
Cummings, OW
Ferrell, LD
Liu, YC
Torbenson, MS
Unalp-Arida, A
Yeh, M
McCullough, AJ
Sanyal, AJ
[J]. HEPATOLOGY, 2005, 41 (06) : 1313 - 1321
[26] A systematic review of a liver-first approach in patients with colorectal cancer and synchronous colorectal liver metastases
Lam, Vincent W. T.
Laurence, Jerome M.
Pang, Tony
Johnston, Emma
Hollands, Michael J.
Pleass, Henry C. C.
Richardson, Arthur J.
[J]. HPB, 2014, 16 (02) : 101 - 108
[27] A Systematic Review of Clinical Response and Survival Outcomes of Downsizing Systemic Chemotherapy and Rescue Liver Surgery in Patients with Initially Unresectable Colorectal Liver Metastases
Lam, Vincent W. T.
Spiro, Calista
Laurence, Jerome M.
Johnston, Emma
Hollands, Michael J.
Pleass, Henry C. C.
Richardson, Arthur J.
[J]. ANNALS OF SURGICAL ONCOLOGY, 2012, 19 (04) : 1292 - 1301
[28] The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer
Law, Wai Lun
Choi, Hok Kwok
Lee, Yee Man
Ho, Judy W. C.
[J]. ANNALS OF SURGICAL ONCOLOGY, 2007, 14 (09) : 2559 - 2566
[29] Chemotherapy Before Liver Resection of Colorectal Metastases Friend or Foe?
Lehmann, Kuno
Rickenbacher, Andreas
Weber, Achim
Pestalozzi, Bernhard C.
Clavien, Pierre-Alain
[J]. ANNALS OF SURGERY, 2012, 255 (02) : 237 - 247
[30] Primary Tumor Versus Liver-First Strategy in Patients with Stage IVA Colorectal Cancer: A Propensity Score Analysis of Long-term Outcomes and Recurrence Pattern
Lim, Chetana
Doussot, Alexandre
Osseis, Michael
Salloum, Chady
Gavara, Concepcion Gomez
Compagnon, Philippe
Brunetti, Francesco
Calderaro, Julien
Azoulay, Daniel
[J]. ANNALS OF SURGICAL ONCOLOGY, 2016, 23 (09) : 3024 - 3032

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