Annals of Surgical Oncology

, Volume 19, Issue 9, pp 2797–2804

Pathologic Response to Preoperative Chemotherapy in Colorectal Liver Metastases: Fibrosis, not Necrosis, Predicts Outcome

  • George A. Poultsides
  • Fei Bao
  • Elliot L. Servais
  • Tina Hernandez-Boussard
  • Ronald P. DeMatteo
  • Peter J. Allen
  • Yuman Fong
  • Nancy E. Kemeny
  • Leonard B. Saltz
  • David S. Klimstra
  • William R. Jarnagin
  • Jinru Shia
  • Michael I. D’Angelica
Colorectal Cancer

DOI: 10.1245/s10434-012-2335-1

Cite this article as:
Poultsides, G.A., Bao, F., Servais, E.L. et al. Ann Surg Oncol (2012) 19: 2797. doi:10.1245/s10434-012-2335-1

Abstract

Background

Pathologic response to preoperative chemotherapy for colorectal liver metastases (CLM) is associated with survival after hepatectomy. Histologically, dominant response patterns include fibrosis, necrosis and/or acellular mucin, but some of these changes can appear without previous chemotherapy and their individual correlation with outcome is unknown.

Methods

Pathology slides from patients who underwent CLM resection (irrespective of preoperative chemotherapy status) were rereviewed by a blinded pathologist. Pathologic response was recorded as the summation of percentage necrosis, fibrosis and acellular mucin. Associations between pathologic response, its components, preoperative chemotherapy, and survival were analyzed.

Results

Pathology slides were rereviewed in 366 patients undergoing CLM resection from 2003 to 2007. Preoperative chemotherapy was administered in 249 (68 %) patients, who, when compared to no preoperative chemotherapy patients, had higher rates of overall pathologic response (57 vs. 46 %, P < .01), fibrosis (21 vs. 12 %, P < .01) and acellular mucin (6 vs. 3 %, P = .05) but similar rates of necrosis (30 vs. 31 %, P = .30). In patients receiving preoperative chemotherapy, overall pathologic response ≥75 % (5 year, 83 vs. 47 %, P < .01) and fibrosis ≥40 % (5 year, 87 vs. 51 %, P < .01) independently correlated with disease-specific survival after hepatectomy. Preoperative hepatic artery infusion chemotherapy (P = .04) and bevacizumab (P = .05) were marginally associated with overall pathologic response and fibrosis, respectively.

Conclusions

Fibrosis is the predominant chemotherapy-related pathologic alteration driving the association of treatment response with survival after CLM resection. Necrosis in CLM is not related to chemotherapy or outcome.

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • George A. Poultsides
    • 1
    • 3
  • Fei Bao
    • 2
    • 5
  • Elliot L. Servais
    • 1
  • Tina Hernandez-Boussard
    • 3
  • Ronald P. DeMatteo
    • 1
  • Peter J. Allen
    • 1
  • Yuman Fong
    • 1
  • Nancy E. Kemeny
    • 4
  • Leonard B. Saltz
    • 4
  • David S. Klimstra
    • 2
  • William R. Jarnagin
    • 1
  • Jinru Shia
    • 2
  • Michael I. D’Angelica
    • 1
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of SurgeryStanford University School of MedicineStanfordUSA
  4. 4.Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  5. 5.Department of PathologyColumbia University College of Physicians and SurgeonsNew YorkUSA