Radiological Morphology of Colorectal Liver Metastases after Preoperative Chemotherapy Predicts Tumor Viability and Postoperative Outcomes

Abstract

Introduction: The computed tomography (CT) morphology after chemotherapy is reportedly correlated with the histopathologic response to chemotherapy and a better surgical outcome in patients with colorectal liver metastases (CLM). However, the true prognostic advantage of CT morphology remains uncertain.

Methods: The prognostic advantage of CT morphology was validated in 86 patients who underwent surgical resection for CLM after undergoing a 5-fluorouracil-based chemotherapy regimen with or without bevacizumab.

Results: An optimal morphologic response was observed in 18 (22.8%) patients, and a strong correlation between the CT morphology and tumor viability was confirmed (P < 0.001). A multivariate analysis revealed that bevacizumab (odds ratio [OR], 6.8; P = 0.03) and chemotherapy cycles ≥6 (OR, 3.6; P = 0.04) were associated with an optimal morphologic response. Overall survival (OS) and recurrence-free survival (RFS) were also predicted by CT morphology with a higher sensitivity. Particularly, a group 1 morphology was associated with a higher OS rate (3-year OS 100%) and RFS rate (3-year RFS, 57.0%), and a multivariate analysis confirmed that group 2 and group 3 tumor morphology was a significant predictive factor for tumor recurrence (hazard ratio [HR], 2.5; P = 0.03 and HR, 3.2; P < 0.01, respectively).

Conclusion: The CT morphology of CLM predicts tumor viability and long-term surgical outcomes after chemotherapy.