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Surgery Today

, Volume 49, Issue 1, pp 82–89 | Cite as

Is neoadjuvant chemotherapy appropriate for patients with resectable liver metastases from colorectal cancer?

  • Fumitoshi Hirokawa
  • Mitsuhiro Asakuma
  • Koji Komeda
  • Tetsunosuke Shimizu
  • Yoshihiro Inoue
  • Syuji Kagota
  • Atsushi Tomioka
  • Kazuhisa Uchiyama
Original Article
  • 154 Downloads

Abstract

Purpose

Neoadjuvant chemotherapy (NAC) for resectable liver metastasis from colorectal cancer (CRLM) is used widely, but its efficacy lacks clear evidence. This study aimed to clarify its worth and develop appropriate treatment strategies for CRLM.

Methods

We analyzed, retrospectively, the clinicopathological factors and outcomes of 137 patients treated for resectable CRLM between 2006 and 2015, with upfront surgery (NAC group; n = 117) or initial NAC treatment (NAC+ group; n = 20).

Results

The time to surgical failure (TSF) and overall survival (OS) after initial treatment were significantly worse in the NAC+ group than in the NAC group (P = 0.002 and P = 0.032, respectively). At hepatectomy, the NAC+ group had a lower median prognostic nutrition index (PNI), higher rates of a positive Glasgow Prognostic Score (P = 0.002) and more perioperative blood transfusions (P = 0.027) than the NAC group. Moreover, the serum albumin (P = 0.006), PNI (P ≤ 0.001) and lymphocyte-to-monocyte ratio (P ≤ 0.001) were significantly decreased and the GPS positive rate was increased from 15 to 35% in the NAC+ group. The OS rates did not differ significantly according to the NAC response (5-year OS rates—CR/PR 67%, SD 60%, PD 38%).

Conclusions

Patients with resectable CRLM should undergo upfront hepatectomy because NAC did not improve OS after initial treatment in these patients.

Keywords

Neoadjuvant chemotherapy Resectable liver metastasis from colorectal cancer (CRLM) Glasgow Prognostic Score 

Notes

Compliance with ethical standards

Conflict of interest

We declare no commercial interest in the subject of this study.

Supplementary material

595_2018_1716_MOESM1_ESM.jpg (46 kb)
Supplementary Fig. 1. Time to surgical failure (TSF) after initial treatment for resectable colorectal liver metastasis in the NAC+ and NAC groups, excluding those NAC+ patients with PD. The TSF rate was significantly better in the NAC group than in the NAC+ group, except if there was a PD after initial treatment (P=0.021). The respective 5-year TSF rate was 62% in the NAC group (n=117, thick line) and 29% in the NAC+ group (n=12, dotted line). (JPG 46 KB)
595_2018_1716_MOESM2_ESM.jpg (48 kb)
Supplementary Fig. 2. Overall survival (OS) after initial treatment for resectable colorectal liver metastasis in the NAC+ and NAC groups, excluding those NAC+ patients with PD. The OS rate was similar for both groups (P=0.468). The respective 5-year OS rate was 66% in the NAC group (n=117, thick line) and 63% in the NAC+ group (n=12, dotted line). (JPG 47 KB)

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Fumitoshi Hirokawa
    • 1
  • Mitsuhiro Asakuma
    • 1
  • Koji Komeda
    • 1
  • Tetsunosuke Shimizu
    • 1
  • Yoshihiro Inoue
    • 1
  • Syuji Kagota
    • 1
  • Atsushi Tomioka
    • 1
  • Kazuhisa Uchiyama
    • 1
  1. 1.Department of General and Gastroenterological SurgeryOsaka Medical CollegeTakatsukiJapan

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