'Favorable' Long-Term Survival Associated with Up-Front Liver Resection and Postsurgical Chemotherapy for Metastatic Colorectal Cancer
“Up-front surgery for patients with resectable CRC liver metastases, followed by chemotherapy, can lead to favorable OS,” reported a team led by Sulaiman Nanji, MD, PhD, of the Department of Surgery at Queen's University, in Kingston, Ontario, Canada.
Combined surgery and chemotherapy is the standard of care for metastatic CRC, but there is not yet consensus about the optimal timing or sequence of liver resection and chemotherapy, the authors wrote.
They performed a retrospective records review of patients who had undergone liver resection from 2002 to 2007 at the largest-volume mCRC liver resection-performing institution in Canada, where patients with resectable hepatic metastases are offered up-front surgery followed by adjuvant 5-fluorouracil-based or capecitabine-based chemotherapy. Of 320 patients, 36 (11%) received preoperative chemotherapy to downstage unresectable disease.
“Actual disease-free survival at 3 and 5 years was 46.2% and 42%, respectively,” Dr. Nanji and coauthors wrote. “Actual overall survival at 3 and 5 years was 63.7% and 55%, respectively.”
Median OS was 35.1 months, the authors reported. Larger metastases (>6 cm), positive lymph node status, synchronous disease at presentation (the presence of hepatic metastases detected before or at the same time as resection of primary colorectal tumors), and absence of postoperative chemotherapy were all significantly associated with poorer OS after multivariate analysis, the authors reported. No association was found between OS and the number of metastatic tumors.
"There was a significant survival advantage in patients who received both postprimary and posthepatectomy chemotherapy (P = 0.041)" over patients who received chemotherapy only for their primary CRC tumors, the authors wrote.
Randomized trials are needed to “more definitively address the timing of perioperative chemotherapy, in addition to the need for prospectively collected data using validated stratification systems to select the best use of these strategies,” the authors concluded.