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What is the Prognostic Value of a Discordant Radiologic and Pathologic Response in Patients Undergoing Resection of Colorectal Liver Metastases After Preoperative Chemotherapy?

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

Abstract

Background

The clinical significance of discordant radiological and pathological response to preoperative chemotherapy of colorectal liver metastases (CLM) is unknown.

Methods

From 2011 to 2016, all eligible patients undergoing resection for CLM after preoperative chemotherapy were included at two centres. Patients were categorized according to radiologic response using RECIST as Rad-responders (complete/partial response) or Rad-non responders (stable disease) and according to Blazer et al. pathologic response grade as Path-responders (complete/major response) or Path-non responders (minor response). Survival outcome was analysed according to radiologic and pathologic response.

Results

Among 413 patients undergoing resection of CLM, 119 fulfilled the inclusion criteria. Among these, 52 (44%) had discordant radiologic and pathologic response including 27 Rad-non responders/path responders and 25 Rad-responders/Path-non responders. Rad-non responders/path responders and Rad-responders/Path-non responders had similar characteristics except for the proportion receiving more than 6 cycles of preoperative chemotherapy (7/27 vs 16/25; P = 0.017). Median disease-free survival was not different in patients with or without discordant radiologic and pathologic responses (P = 0.195) but the type of discordance had an impact on oncologic outcome as median disease-free survival was 13.9 months (95% CI 5.7–22.2 months) in Rad-non responders/Path responders and 8.6 (6.2 – 10.9 months) in Rad-responders/Path-non responders (P = 0.034). Univariate and multivariate analysis showed that major pathologic response was associated with improved disease-free survival (OR 0.583, 95% CI 0.36–0.95, P = 0.031).

Conclusion

A discordant radiologic and pathologic response is common after preoperative chemotherapy for CLM. In these patients, pathologic response drives oncologic outcome.

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References

  1. Nordlinger B, Sorbye H, Glimelius B, 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.

    Article  CAS  Google Scholar 

  2. Allen PJ, Kemeny N, Jarnagin W, et al. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–17.

    Article  Google Scholar 

  3. Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61 (discussion 1061–1064).

    Article  Google Scholar 

  4. Blazer DG, Kishi Y, Maru DM, et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol. 2008;26:5344–51.

    Article  Google Scholar 

  5. Rubbia-Brandt L, Giostra E, Brezault C, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304.

    Article  CAS  Google Scholar 

  6. Chun YS, Vauthey J-N, Boonsirikamchai P, et al. Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA. 2009;302:2338–44.

    Article  CAS  Google Scholar 

  7. Brouquet A, Zimmitti G, Kopetz S, et al. Multicenter validation study of pathologic response and tumor thickness at the tumor-normal liver interface as independent predictors of disease-free survival after preoperative chemotherapy and surgery for colorectal liver metastases. Cancer. 2013;119:2778–88.

    Article  Google Scholar 

  8. Berardi G, De Man M, Laurent S, et al. Radiologic and pathologic response to neoadjuvant chemotherapy predicts survival in patients undergoing the liver-first approach for synchronous colorectal liver metastases. Eur J Surg Oncol. 2018;44:1069–77.

    Article  Google Scholar 

  9. Viganò L, Capussotti L, Barroso E, et al. Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases. Ann Surg Oncol. 2012;19:2786–96.

    Article  Google Scholar 

  10. Brouquet A, Nordlinger B. Neoadjuvant therapy of colorectal liver metastases: lessons learned from clinical trials. J Surg Oncol. 2010;102:932–6.

    Article  Google Scholar 

  11. Benoist S, Brouquet A, Penna C, et al. Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol. 2006;24:3939–45.

    Article  Google Scholar 

  12. Shindoh J, Loyer EM, Kopetz S, et al. Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases. J Clin Oncol. 2012;30:4566–72.

    Article  CAS  Google Scholar 

  13. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.

    Article  CAS  Google Scholar 

  14. Hosseini-Nik H, Fischer SE, Moulton C-AE, et al. Diffusion-weighted and hepatobiliary phase gadoxetic acid-enhanced quantitative MR imaging for identification of complete pathologic response in colorectal liver metastases after preoperative chemotherapy. Abdom Radiol N Y. 2016;41:231–8.

    Article  Google Scholar 

  15. Nishioka Y, Yoshioka R, Gonoi W, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography as an objective substitute for CT morphologic response criteria in patients undergoing chemotherapy for colorectal liver metastases. Abdom Radiol NY. 2018;43:1152–58.

    Article  Google Scholar 

  16. de Gramont A, Van Cutsem E, Schmoll H-J, et al. Bevacizumab plus oxaliplatin-based chemotherapy as adjuvant treatment for colon cancer (AVANT): a phase 3 randomised controlled trial. Lancet Oncol. 2012;13:1225–33.

    Article  Google Scholar 

  17. Primrose J, Falk S, Finch-Jones M, et al. Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis: the New EPOC randomised controlled trial. Lancet Oncol. 2014;15:601–11.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank the PREDI association (association pour la recherche en chirurgie digestive) for its support.

Funding

No funding was received in support of this work.

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Author notes

  1. Antoine Brouquet and Christelle Blot have contributed equally to this work.

Authors and Affiliations

  1. Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Sud, Le Kremlin Bicêtre, France

    Antoine Brouquet MD, PhD, Christelle Blot MD, Christophe Penna MD & Stephane Benoist MD, PhD

  2. Paris-Sud University, Le Kremlin Bicêtre, France

    Antoine Brouquet MD, PhD, Christelle Blot MD, Marc-Antoine Allard MD, PhD, Mylène Sebbagh MD, Maïté Lewin MD, René Adam MD, Christophe Penna MD, Antonio Sa Cunha MD, PhD & Stephane Benoist MD, PhD

  3. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France

    Marc-Antoine Allard MD, PhD, René Adam MD & Antonio Sa Cunha MD, PhD

  4. Department of Pathology, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin Bicêtre, France

    Thierry Lazure MD & Mylène Sebbagh MD

  5. Department of Radiology, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin Bicêtre, France

    Mathilde Gayet MD

  6. Department of Radiology, Paul Brousse Hospital, APHP, Paris-Sud University, Le Kremlin Bicêtre, France

    Maïté Lewin MD

Authors
  1. Antoine Brouquet MD, PhD
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  2. Christelle Blot MD
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  8. René Adam MD
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  9. Christophe Penna MD
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  10. Antonio Sa Cunha MD, PhD
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  11. Stephane Benoist MD, PhD
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Corresponding author

Correspondence to Antoine Brouquet MD, PhD.

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Disclosure

AB: Speaker fees: Takeda, Merck-Serono, Abbvie, Roche, Amgen, Janssen-Cilag; Invitations to scientific meetings: Biom’up, Eumedica, Nestlé, Roche; ASC: Scientific boards: Merck, Baxter; Lectures: ROCHE; Merck, Servier; Meeting expenses: Biom’up, Sanofi; SB: Boards: Amgen, Biom’up; Oral presentations: Amgen, Roche, Merck Serono, Nestlé, Servier, Sanofi; Invitations to congresses: Biom’up, Merck, Roche; Other co-authors (CB, MAA, TL, MS, MG, ML, RA, CP) have no conflicts of interest to declare.

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Brouquet, A., Blot, C., Allard, MA. et al. What is the Prognostic Value of a Discordant Radiologic and Pathologic Response in Patients Undergoing Resection of Colorectal Liver Metastases After Preoperative Chemotherapy?. Ann Surg Oncol 27, 2877–2885 (2020). https://doi.org/10.1245/s10434-020-08284-1

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  • DOI: https://doi.org/10.1245/s10434-020-08284-1

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