Type of adjuvant chemotherapy and treatment frequency in survival outcome of patients with colorectal liver metastases who underwent liver metastasectomy: an 8-year cohort study in Taiwan
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The role of adjuvant chemotherapy (ACT) in treating patients who have colorectal liver metastases (CLM) and undergo liver metastasectomy (LMS) is unclear in this patient population. We aimed to compare the mortality of patients receiving different ACT (i.e., oxaliplatin-based, irinotecan-based, and 5-fluorouracil-only (5FU)) and different treatment frequencies.
We included 2583 patients with CLM who underwent LMS (including synchronous LMS [SLMS] and metachronous LMS [MLMS]) in this retrospective cohort study. We used Cox proportional hazard model to obtain hazard ratios (HRs) for mortality. The reference group was 5FU-only ACT when comparing ACT type and the reference group was treatment for ≤ 3 times when comparing ACT frequency.
In SLMS patients, oxaliplatin-based ACT (HR = 0.78) and receiving ACT for ≥ 4 times (4–6 times, HR = 0.61; 7–9 times, HR = 0.69; 10–12 times, HR = 0.66) were associated with lower risk of mortality. In MLMS patients, oxaliplatin-based ACT (HR = 0.52), irinotecan-based ACT (HR = 0.64), and receiving ACT for 10–12 times (HR = 0.65) were associated with lower risk of mortality.
In SLMS and MLMS patients, patients who received oxaliplatin-based ACT were more likely to survive than patients who received 5FU-only ACT. In MLMS patients, patients who received irinotecan-based ACT were also more likely to survive than those who received 5FU-only ACT. We recommend a course of at least four to six times of ACT after LMS in this patient population.
KeywordsColorectal cancer Liver metastasis Oxaliplatin Irinotecan Adjuvant chemotherapy
This study is based in part on data from the NHIRD provided by the Bureau of National Health Insurance, Department of Health, and managed by the National Health Research Institutes (Registered number 101095, 102148). The interpretation and conclusions contained herein do not represent the views of the Bureau of National Health Insurance, Department of Health or National Health Research Institutes. Our study was exempt from the requirement of institutional review board approval because we used de-identified secondary data. The authors would like to thank Dr. Ching-Heng Lin in the Department of Medical Research, Taichung Veterans General Hospital, for the support of study design and conduct. We would also like to thank the Healthcare Service Research Center of Taichung Veterans General Hospital for the statistical support.
Compliance with ethical standards
This study was approved by the ethical review board of the Taichung Veterans General Hospital (CE13151-1).
Conflict of interest
The authors declare that they have no conflict of interest.
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