Journal of Gastrointestinal Surgery

, Volume 13, Issue 1, pp 74–84 | Cite as

Multiagent Chemotherapy for Isolated Colorectal Liver Metastases: A Single-centered Retrospective Study

  • Srinevas K. Reddy
  • Gloria Broadwater
  • Donna Niedzwiecki
  • Andrew S. Barbas
  • Herbert I. Hurwitz
  • Johanna C. Bendell
  • Michael A. Morse
  • Bryan M. Clary
original article

Abstract

Background

Few studies identifying variables associated with prognosis after resection of colorectal liver metastases (CLM) account for treatment with multiagent chemotherapy (fluoropyrmidines with irinotecan, oxaliplatin, bevacizumab, and/or cetuximab). The objective of this retrospective study was to determine the effect of multiagent chemotherapy on long-term survival after resection of CLM.

Methods

Demographics, clinicopathologic tumor characteristics, treatments, and long-term outcomes were reviewed.

Results

From 1996 to 2006, 230 patients underwent resection of CLM. Treatment strategies before and after resection included fluoropyrimidine monotherapy (n = 34 and n = 39), multiagent chemotherapy (n = 81 and n = 73), and observation (n = 115 and n = 118). Prehepatectomy treatment strategy was not associated with overall survival. Actuarial 4-year survival was 63%, 39%, and 40% for patients treated with multiagent chemotherapy, fluoropyrimidine monotherapy, and observation after hepatectomy, p = 0.06. Posthepatectomy multiagent chemotherapy (p = 0.04, HR 0.52 [0.27–1.03]), duration of posthepatectomy chemotherapy treatment of 2 months or longer (p = 0.05, HR 0.49 [0.25–0.99]), carcino-embryonic antigen level >10 ng/mL (p = 0.03, HR 2.09, 95% CI [1.32–3.32]), and node positive primary tumor (p = 0.002, HR 1.79 [1.06–3.02]) were associated with overall survival in multivariate analysis.

Conclusions

The association of posthepatectomy multiagent chemotherapy with overall survival in this retrospective study indicates the need for prospective randomized trials comparing multiagent chemotherapy and fluoropyrimidine monotherapy for CLM.

Keywords

Colorectal liver metastases Chemotherapy Hepatic resection 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Srinevas K. Reddy
    • 1
  • Gloria Broadwater
    • 2
  • Donna Niedzwiecki
    • 3
  • Andrew S. Barbas
    • 1
  • Herbert I. Hurwitz
    • 4
  • Johanna C. Bendell
    • 4
  • Michael A. Morse
    • 4
  • Bryan M. Clary
    • 1
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Department of Cancer Center BiostatisticsDuke University Medical CenterDurhamUSA
  3. 3.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA
  4. 4.Department of MedicineDuke University Medical CenterDurhamUSA

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