Is neoadjuvant chemotherapy appropriate for patients with resectable liver metastases from colorectal cancer?
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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.
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).
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%).
Patients with resectable CRLM should undergo upfront hepatectomy because NAC did not improve OS after initial treatment in these patients.
KeywordsNeoadjuvant chemotherapy Resectable liver metastasis from colorectal cancer (CRLM) Glasgow Prognostic Score
Compliance with ethical standards
Conflict of interest
We declare no commercial interest in the subject of this study.
- 3.Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.CrossRefPubMedCentralGoogle Scholar
- 4.Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14:1208–15.CrossRefGoogle Scholar
- 7.Mutoh T, editor. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. 7th ed; Tokyo: Kanehara; 2006.Google Scholar
- 8.Oba M, Hasegawa K, Matsuyama Y, Shindoh J, Mise Y, Aoki T, et al. Discrepancy between recurrence-free survival and overall survival in patients with resectable colorectal liver metastases: a potential surrogate endpoint for time to surgical failure. Ann Surg Oncol. 2014;21:1817–24.CrossRefPubMedCentralGoogle Scholar
- 11.National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. 2012; ver 2.Google Scholar
- 16.de Jong MC, Mayo SC, Pulitano C, Lanella S, Ribero D, Strub J, et al. Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis. J Gastrointest Surg. 2009;13:2141–51.CrossRefPubMedCentralGoogle Scholar
- 22.Neofytou K, Smyth EC, Giakoustidis A, Khan AZ, Cunningham D, Mudan S. Elevated platelet to lymphocyte ratio predicts poor prognosis after hepatectomy for liver-only colorectal metastases, and it is superior to neutrophil to lymphocyte ratio as an adverse prognostic factor. Med Oncol. 2014;31:239.CrossRefPubMedCentralGoogle Scholar
- 23.Neofytou K, Smyth EC, Giakoustidis A, Khan AZ, Williams R, Cunningham D, et al. The preoperative lymphocyte-to-monocyte ratio is prognostic of clinical outcomes for patients with liver-only colorectal metastases in the neoadjuvant setting. Ann Surg Oncol. 2015;22:4353–62.CrossRefPubMedCentralGoogle Scholar
- 25.Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004;90:1704–6.CrossRefPubMedCentralGoogle Scholar