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Progression of Colorectal Liver Metastases from the End of Chemotherapy to Resection: A New Contraindication to Surgery?

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Not all patients with resectable colorectal liver metastases (CLM) benefit from liver resection (LR); only patients with disease progression during chemotherapy are excluded from surgery.

Objective

This study was performed to determine whether tumor behavior (stable disease/progression) from the end of chemotherapy to LR impacts prognosis.

Methods

Patients undergoing LR after tumor response or stabilization during chemotherapy were considered. Overall, 128 patients who underwent examination by two imaging modalities (computed tomography/magnetic resonance imaging) after chemotherapy with a > 3-week interval between the two imaging modalities were analyzed. Any variation in CLM size was registered. Tumor progression was defined according to the response evaluation criteria in solid tumors (RECIST) criteria.

Results

Among 128 patients with stable disease or partial response to preoperative chemotherapy, 32 (25%) developed disease progression in the chemotherapy to LR interval, with a disease progression rate of 17% when this interval was < 8 weeks. Survival was lower among patients with progression than those with stable disease [3-year overall survival (OS) 23.0 vs. 52.4%, and recurrence-free survival (RFS) 6.3% vs. 21.6%; p < 0.001]. Survival was extremely poor in patients with early progression (< 8 weeks) (0.0% 2-year OS, 12.5% 6-month RFS). Disease progression in the chemotherapy to LR interval was an independent negative prognostic factor for OS and RFS [hazard ratio 3.144 and 2.350, respectively; p < 0.001].

Conclusions

Early disease progression in the chemotherapy to LR interval occurred in approximately 15% of patients and was associated with extremely poor survival. Even if these data require validation, the risk for early disease progression after chemotherapy should be considered, and, if progression is evident, the indication for surgery should be cautiously evaluated.

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Disclosure

Luca Vigano, Shadya Sara Darwish, Lorenza Rimassa, Matteo Cimino, Carlo Carnaghi, Matteo Donadon, Fabio Procopio, Nicola Personeni, Daniele Del Fabbro, Armando Santoro, and Guido Torzilli have no conflicts of interest to declare.

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Authors and Affiliations

  1. Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center – IRCCS, Humanitas University, Rozzano, Milan, Italy

    Luca Vigano MD, PhD, Shadya Sara Darwish MD, Matteo Cimino MD, Matteo Donadon MD, PhD, Fabio Procopio MD, Daniele Del Fabbro MD & Guido Torzilli MD, PhD, FACS

  2. Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy

    Lorenza Rimassa MD, Carlo Carnaghi MD, Nicola Personeni MD & Armando Santoro MD

Authors
  1. Luca Vigano MD, PhD
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  2. Shadya Sara Darwish MD
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  3. Lorenza Rimassa MD
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  4. Matteo Cimino MD
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  5. Carlo Carnaghi MD
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  11. Guido Torzilli MD, PhD, FACS
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Corresponding author

Correspondence to Guido Torzilli MD, PhD, FACS.

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Vigano, L., Darwish, S.S., Rimassa, L. et al. Progression of Colorectal Liver Metastases from the End of Chemotherapy to Resection: A New Contraindication to Surgery?. Ann Surg Oncol 25, 1676–1685 (2018). https://doi.org/10.1245/s10434-018-6387-8

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  • DOI: https://doi.org/10.1245/s10434-018-6387-8

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