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Recurrence Patterns After Resection of Colorectal Liver Metastasis are Modified by Perioperative Systemic Chemotherapy

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Abstract

Background

This study investigated the impact of perioperative systemic chemotherapy on the recurrence rate and pattern following resection of colorectal liver metastases.

Methods

A retrospective cohort study was conducted in two centers. Rates and patterns of recurrence and overall survival (OS) were compared between patients treated with and without perioperative systemic chemotherapy. The clinical risk score (CRS) was used to stratify patients in low risk (CRS 0–2) and high risk (CRS 3–5) of recurrence.

Results

A total of 2020 patients were included, of whom 1442 (71%) received perioperative systemic chemotherapy. The median follow-up was 88 months, and 1289 patients (64%) developed a recurrence. The recurrence pattern was independent of chemotherapy in low-risk patients: intrahepatic recurrences (30% vs. 30%, p = 0.97) and extrahepatic recurrences (38% vs. 39%, p = 0.52). In high-risk patients, no difference in intrahepatic recurrences was found (48% vs. 50%, p = 0.59). However, a lower rate of extrahepatic recurrences (43% vs. 55%, p = 0.007) was observed with perioperative systemic chemotherapy, mainly due to a reduction in pulmonary recurrences (25% vs. 35%, p = 0.007). In competing risk analysis, the cumulative incidence of extrahepatic recurrence was significantly lower with perioperative systemic chemotherapy in high-risk patients only (5-year cumulative incidence 44% vs. 59%, p < 0.001). Perioperative chemotherapy was associated with improved OS in high-risk patients (adjusted HR 0.73, 95% CI 0.57–0.94, p = 0.02), but not in low-risk patients (adjusted HR 0.99, 95% CI 0.82–1.19, p = 0.90).

Conclusions

Perioperative systemic chemotherapy had no association with intrahepatic recurrence, but was associated with fewer pulmonary recurrences and superior OS in high-risk patients only.

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Authors and Affiliations

  1. Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    Florian E. Buisman, Boris Galjart, Eric P. van der Stok, Dirk J. Grünhagen, Cornelis Verhoef & Bas Groot Koerkamp

  2. Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Vinod P. Balachandran, Thomas Boerner, Jeffrey A. Drebin, William R. Jarnagin, T. Peter Kingham & Micheal I. D’Angelica

Authors
  1. Florian E. Buisman
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  2. Boris Galjart
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  3. Eric P. van der Stok
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  4. Vinod P. Balachandran
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  5. Thomas Boerner
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  6. Jeffrey A. Drebin
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  7. Dirk J. Grünhagen
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  8. William R. Jarnagin
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  9. T. Peter Kingham
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  10. Cornelis Verhoef
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  11. Micheal I. D’Angelica
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  12. Bas Groot Koerkamp
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Correspondence to Bas Groot Koerkamp.

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Appendix

Appendix

See Tables 5, 6 and Figs. 5, 6.

Table 5 Number of patients according to CRS class
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Table 6 Recurrence rate’s according to CRS class
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Fig. 5
figure 5

Cumulative incidence function for location-specific recurrence for CRS 0, 1 and 2

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Fig. 6
figure 6

Cumulative incidence function for location-specific recurrence for CRS 3, 4 and 5

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Buisman, F.E., Galjart, B., van der Stok, E.P. et al. Recurrence Patterns After Resection of Colorectal Liver Metastasis are Modified by Perioperative Systemic Chemotherapy. World J Surg 44, 876–886 (2020). https://doi.org/10.1007/s00268-019-05121-9

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  • DOI: https://doi.org/10.1007/s00268-019-05121-9

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