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The survival benefit of neoadjuvant chemotherapy for resectable colorectal liver metastases with high tumor burden score

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Abstract

Background

The indications for neoadjuvant chemotherapy (NAC) in resectable colorectal liver metastases (CRLMs) remain unclear. Tumor burden score (TBS) is a prognostic tool based on tumor size and number of tumors. However, its utility in the NAC setting for initially resectable CRLM has never been investigated.

Methods

TBS is a distance from the origin on a Cartesian plane to the coordinates (x, y) = (tumor size in centimeter, number of tumors). TBS < 3 was defined as “TBS-low”, whereas TBS ≥ 3 as “TBS-high”. Between 2008 and 2018, 102 patients who underwent hepatectomy for resectable CRLM were retrospectively analyzed using the Kaplan–Meier method and Cox proportional hazards regression models.

Results

Among the TBS-low (n = 46) and TBS-high (n = 56) groups, baseline patient characteristics were mostly similar except for TBS-related parameters. NAC was more frequently administered in the TBS-high group (p = 0.038). The overall survival (OS) rates were similar between the two groups. Subgroup analysis showed that NAC was associated with non-significantly improved 5-year OS in the TBS-high group [76.1% with NAC and 54.9% without NAC (p = 0.093)]. In multivariate analysis, NAC was an independent prognostic factor for favorable OS only in the TBS-high group, while adjuvant chemotherapy (AC) was associated with improved OS only in the TBS-low group.

Conclusion

In patients with resectable CRLM, the TBS-high population had a survival benefit from NAC, while the TBS-low population benefited from AC. TBS may serve as an indicator for patients who will benefit from NAC.

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Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Yoshihiko Yonekawa, Kay Uehara, Takashi Mizuno, Toshisada Aiba, Atsushi Ogura, Toshiki Mukai, Yukihiro Yokoyama, Tomoki Ebata & Masato Nagino

  2. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yasuhiro Kodera

Authors
  1. Yoshihiko Yonekawa
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  2. Kay Uehara
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  3. Takashi Mizuno
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  4. Toshisada Aiba
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  5. Atsushi Ogura
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  6. Toshiki Mukai
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  7. Yukihiro Yokoyama
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  8. Tomoki Ebata
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  9. Yasuhiro Kodera
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  10. Masato Nagino
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Corresponding author

Correspondence to Kay Uehara.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This study was retrospective observational study. Therefore, informed consent was not obtained from all individual participants included in the study and it was approved by the Nagoya University Hospital Institutional Review Board.

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Yonekawa, Y., Uehara, K., Mizuno, T. et al. The survival benefit of neoadjuvant chemotherapy for resectable colorectal liver metastases with high tumor burden score. Int J Clin Oncol 26, 126–134 (2021). https://doi.org/10.1007/s10147-020-01793-9

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  • DOI: https://doi.org/10.1007/s10147-020-01793-9

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