original article

Journal of Gastrointestinal Surgery

, Volume 13, Issue 1, pp 74-84

Multiagent Chemotherapy for Isolated Colorectal Liver Metastases: A Single-centered Retrospective Study

  • Srinevas K. ReddyAffiliated withDepartment of Surgery, Duke University Medical Center Email author 
  • , Gloria BroadwaterAffiliated withDepartment of Cancer Center Biostatistics, Duke University Medical Center
  • , Donna NiedzwieckiAffiliated withDepartment of Biostatistics and Bioinformatics, Duke University Medical Center
  • , Andrew S. BarbasAffiliated withDepartment of Surgery, Duke University Medical Center
  • , Herbert I. HurwitzAffiliated withDepartment of Medicine, Duke University Medical Center
  • , Johanna C. BendellAffiliated withDepartment of Medicine, Duke University Medical Center
  • , Michael A. MorseAffiliated withDepartment of Medicine, Duke University Medical Center
  • , Bryan M. ClaryAffiliated withDepartment of Surgery, Duke University Medical Center

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Abstract

Background

Few studies identifying variables associated with prognosis after resection of colorectal liver metastases (CLM) account for treatment with multiagent chemotherapy (fluoropyrmidines with irinotecan, oxaliplatin, bevacizumab, and/or cetuximab). The objective of this retrospective study was to determine the effect of multiagent chemotherapy on long-term survival after resection of CLM.

Methods

Demographics, clinicopathologic tumor characteristics, treatments, and long-term outcomes were reviewed.

Results

From 1996 to 2006, 230 patients underwent resection of CLM. Treatment strategies before and after resection included fluoropyrimidine monotherapy (n = 34 and n = 39), multiagent chemotherapy (n = 81 and n = 73), and observation (n = 115 and n = 118). Prehepatectomy treatment strategy was not associated with overall survival. Actuarial 4-year survival was 63%, 39%, and 40% for patients treated with multiagent chemotherapy, fluoropyrimidine monotherapy, and observation after hepatectomy, p = 0.06. Posthepatectomy multiagent chemotherapy (p = 0.04, HR 0.52 [0.27–1.03]), duration of posthepatectomy chemotherapy treatment of 2 months or longer (p = 0.05, HR 0.49 [0.25–0.99]), carcino-embryonic antigen level >10 ng/mL (p = 0.03, HR 2.09, 95% CI [1.32–3.32]), and node positive primary tumor (p = 0.002, HR 1.79 [1.06–3.02]) were associated with overall survival in multivariate analysis.

Conclusions

The association of posthepatectomy multiagent chemotherapy with overall survival in this retrospective study indicates the need for prospective randomized trials comparing multiagent chemotherapy and fluoropyrimidine monotherapy for CLM.

Keywords

Colorectal liver metastases Chemotherapy Hepatic resection