Postoperative prophylactic hepatic arterial infusion chemotherapy for stage III colorectal cancer: a retrospective study

Abstract

Background: Radical resection is the main treatment for colorectal cancer (CRC), but metastasis or recurrence is common in which liver metastasis accounted for 83% of the cases. Therefore, the prognosis of patients with advanced CRC may be improved if liver metastasis is prevented. This study aims to investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) on liver metastases of stage III CRC patients after curative resection.

Methods: Between 2002 and 2008, 287 stage III CRC patients who had undergone radical resection were included in this study. According to postoperative adjuvant chemotherapy modality, these patients were divided into two groups. Patients in the combined therapy group received two cycles of HAIC plus four cycles of systemic chemotherapy, while patients in the monotherapy group received six cycles of systemic chemotherapy alone. The HAIC regimen consisted of hepatic arterial infusion of oxaliplatin (OXA, 85 mg/m²) on day 1 and 5-fluorouracil (5-FU, 2,400 mg/m²) on days 2 and 3 followed by a vein infusion of folinic acid (FA, 200 mg/m²) as a 2-hour infusion on days 2 and 3. The systemic chemotherapy regimen consisted of a 2-hour infusion of OXA (85 mg/m²) on day 1 followed by FA (200 mg/m²) as a 2-hour infusion on days 2 and 3, and by 5-FU (2,400 mg/m²) as a 48-hour infusion. This was repeated every 4 weeks. All cases were followed up for 5 years or until death. The 5-year overall survival, disease-free survival, liver metastases-free survival, and the overall liver metastases rates were retrospectively compared.

Results: Significant differences were found in the 5-year overall survival (combined therapy, 70.71%; monotherapy, 57.14%; P=0.014), disease-free survival (combined therapy, 69.29%; monotherapy, 55.78%; P=0.021), and liver metastases-free survival rates (combined therapy, 70%; monotherapy, 56.46%; P=0.019).

Conclusion: Prophylactic adjuvant HAIC can prevent metachronous liver metastases and improve the prognosis of patients with stage III CRC after curative resection.

Keywords: chemotherapy; colorectal cancer; hepatic arterial infusion chemotherapy; liver metastases.

Figure 1

Disease-free survival curves after curative resection of stage III colorectal cancer. The probability of disease-free survival at 5 years was 69.29% in combined therapy group and 55.78% in the monotherapy group (P=0.021 by log-rank test).

Figure 2

Overall survival curves after curative resection of stage III colorectal cancer. The probability of overall survival at 5 years was 70.71% in the combined therapy group and 57.14% in the monotherapy group (P=0.014 by log-rank test).

Figure 3

Liver metastases-free survival curves after curative resection of stage III colorectal cancer. The 5-year actuarial rate of liver metastases-free survival was 70.00% in the combined therapy group and 56.46% in the monotherapy group (P=0.019 by log-rank test).