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Clinical Trial
. 2016 May:59:13-21.
doi: 10.1016/j.ejca.2016.02.003. Epub 2016 Mar 16.

Management of liver metastases in colorectal cancer patients: A retrospective case-control study of systemic therapy versus liver resection

Jannemarie A M de Ridder  1 , Eric P van der Stok  2 , Leonie J Mekenkamp  3 , Bastiaan Wiering  4 , Miriam Koopman  5 , Cornelis J A Punt  3 , Cornelis Verhoef  2 , Johannes H de Wilt  6
Affiliations
Clinical Trial

Management of liver metastases in colorectal cancer patients: A retrospective case-control study of systemic therapy versus liver resection

Jannemarie A M de Ridder et al. Eur J Cancer. 2016 May.

Abstract

Objective: To evaluate and compare the overall survival (OS) in case-matched patient groups treated either with systemic therapy or surgery for colorectal liver metastases (CRLM).

Methods: Patients with CRLM, without extra-hepatic disease, treated with chemotherapy with or without targeted therapy in two phase III studies (n = 480) were selected and case-matched to patients who underwent liver resection (n = 632). Matching criteria were sex, age, established prognostic factors for survival (clinical risk score). Available computed tomography (CT)-scans of patients treated with systemic therapies were reviewed by three independent liver surgeons for resectability. Survival was compared between patients with resectable CRLM (based on CT-scan review) who were treated with systemic therapy versus patients who underwent liver resection.

Results: A total of 96 patients treated with systemic therapy were included. Pre-treatment CT-scans of the liver were available for review in 56 of the systemically treated patients, and metastases were unanimously considered resectable in 36 patients (64.3%) (complex resectable: n = 25; 69%). These 36 patients were case-matched with 36 patients who underwent liver resection (wedge resection or segmentectomy: n = 26; 72%). Median OS in the patient group treated with systemic therapy was 26.5 months (range 0-81 months), which was significantly lower than that in case-matched patients who underwent liver resection (median OS 56 months; range 6-116) (p = 0.027).

Conclusions: In this case-matched control study, surgery provided superior OS rates compared to systemic therapy for CRLM. Resection of CRLM should always be considered, preferably in a dedicated liver centre, since not all patients that qualify for resection are identified as such.

Keywords: Colorectal liver metastases; Liver resection; Surgical treatment; Survival; Systemic therapy; Treatment.

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