Progression while Receiving Preoperative Chemotherapy Should Not Be an Absolute Contraindication to Liver Resection for Colorectal Metastases View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2012-05-24

AUTHORS

Luca Viganò, Lorenzo Capussotti, Eduardo Barroso, Gennaro Nuzzo, Christophe Laurent, Jan N. M. Ijzermans, Jean-François Gigot, Joan Figueras, Thomas Gruenberger, Darius F. Mirza, Dominique Elias, Graeme Poston, Christian Letoublon, Helena Isoniemi, Javier Herrera, Francisco Castro Sousa, Fernando Pardo, Valerio Lucidi, Irinel Popescu, René Adam

ABSTRACT

PurposeTumor 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.MethodsData 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.ResultsAmong 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 ≥50 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.ConclusionsPD 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. More... »

PAGES

2786-2796

Journal

TITLE

Annals of Surgical Oncology

ISSUE

9

VOLUME

19

Author Affiliations

  • Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
  • Department of HPB Surgery and Transplantation, Curry Cabral Hospital, Lisbon, Portugal
  • Hepatobiliary Unit, Department of Surgery, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
  • Department of Surgery, Hôpital Saint André, Bordeaux, France
  • Department of Transplantation and Hepato-biliary Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
  • Unit of HPB Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
  • Department of Surgery, “Josep Trueta” Hospital, Girona, Spain
  • Department of Surgery, Medical University of Vienna, Vienna, Austria
  • Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
  • Department of Surgery, Institute Gustave Roussy, Villejuif, France
  • Department of Surgery, University Hospital Aintree, Liverpool, UK
  • Department of Digestive and Emergency Surgery, University Hospital, University Joseph Fourier, Grenoble, France
  • Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland
  • Department of Surgery, Navarra Hospital, Pamplona, Spain
  • Department of Surgery, Surgery 3, Coimbra University Hospital, Coimbra, Portugal
  • Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain
  • Liver Transplantation Unit, Department of Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
  • Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
  • AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Sud, Villejuif, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1245/s10434-012-2382-7

    DOI

    http://dx.doi.org/10.1245/s10434-012-2382-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1031829239

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/22622469


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    38 schema:description PurposeTumor 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.MethodsData 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.ResultsAmong 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 ≥50 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.ConclusionsPD 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.
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