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. 2012 Dec 20;30(36):4566-72.
doi: 10.1200/JCO.2012.45.2854. Epub 2012 Nov 13.

Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases

Junichi Shindoh  1 , Evelyne M Loyer, Scott Kopetz, Piyaporn Boonsirikamchai, Dipen M Maru, Yun Shin Chun, Giuseppe Zimmitti, Steven A Curley, Chusilp Charnsangavej, Thomas A Aloia, Jean-Nicolas Vauthey
Affiliations

Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases

Junichi Shindoh et al. J Clin Oncol. .

Abstract

Purpose: The purposes of this study were to confirm the prognostic value of an optimal morphologic response to preoperative chemotherapy in patients undergoing chemotherapy with or without bevacizumab before resection of colorectal liver metastases (CLM) and to identify predictors of the optimal morphologic response.

Patients and methods: The study included 209 patients who underwent resection of CLM after preoperative chemotherapy with oxaliplatin- or irinotecan-based regimens with or without bevacizumab. Radiologic responses were classified as optimal or suboptimal according to the morphologic response criteria. Overall survival (OS) was determined, and prognostic factors associated with an optimal response were identified in multivariate analysis.

Results: An optimal morphologic response was observed in 47% of patients treated with bevacizumab and 12% of patients treated without bevacizumab (P < .001). The 3- and 5-year OS rates were higher in the optimal response group (82% and 74%, respectively) compared with the suboptimal response group (60% and 45%, respectively; P < .001). On multivariate analysis, suboptimal morphologic response was an independent predictor of worse OS (hazard ratio, 2.09; P = .007). Receipt of bevacizumab (odds ratio, 6.71; P < .001) and largest metastasis before chemotherapy of ≤ 3 cm (odds ratio, 2.12; P = .025) were significantly associated with optimal morphologic response. The morphologic response showed no specific correlation with conventional size-based RECIST criteria, and it was superior to RECIST in predicting major pathologic response.

Conclusion: Independent of preoperative chemotherapy regimen, optimal morphologic response is sufficiently correlated with OS to be considered a surrogate therapeutic end point for patients with CLM.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Optimal and suboptimal morphologic response after chemotherapy. (A and B) Optimal morphologic response and RECIST stable disease. (C and D) Suboptimal response and RECIST stable disease.
Fig 2.
Fig 2.
(A) Overall survival and (B) disease-free survival by morphologic response in 209 patients undergoing resection of colorectal liver metastases after preoperative chemotherapy.
Fig 3.
Fig 3.
Overall survival and morphologic response according to preoperative chemotherapy: (A) with bevacizumab and (B) without bevacizumab.
See this image and copyright information in PMC

References

    1. Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818–825. - PMC - PubMed
    1. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235:759–766. - PMC - PubMed
    1. Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–722. - PMC - PubMed
    1. Kopetz S, Vauthey JN. Perioperative chemotherapy for resectable hepatic metastases. Lancet. 2008;371:963–965. - PubMed
    1. Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: A model to predict long-term survival. Ann Surg. 2004;240:644–657. - PMC - PubMed

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