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. 2019 Jun 13;17(1):100.
doi: 10.1186/s12957-019-1641-5.

Optimal indication criteria for neoadjuvant chemotherapy in patients with resectable colorectal liver metastases

Hirofumi Ichida  1 , Yoshihiro Mise  1 , Hiromichi Ito  1 , Takeaki Ishizawa  1 , Yosuke Inoue  1 , Yu Takahashi  1 , Eiji Shinozaki  2 , Kensei Yamaguchi  2 , Akio Saiura  3
Affiliations

Optimal indication criteria for neoadjuvant chemotherapy in patients with resectable colorectal liver metastases

Hirofumi Ichida et al. World J Surg Oncol. .

Abstract

Background: There are no optimal indication criteria for neoadjuvant chemotherapy (NAC) in patients with resectable colorectal liver metastases (CLM). The aim of this study was to prospectively assess the survival benefit of selective NAC administration in this patient population based on tumor characteristics.

Methods: Borderline resectable CLM (BR-CLM) were defined as four or more liver metastases, CLM larger than 5 cm, or CLM with concomitant resectable extrahepatic metastases. From 2010 to 2015, NAC was administered to BR-CLM patients. Upfront surgery without NAC was performed to patients having clearly resectable CLM (less than 3 lesions, smaller than 5 cm, and no extrahepatic metastases: CR-US group). Survival outcomes of the two groups were assessed.

Results: The BR-NAC group comprised 73 patients and the CR-US group 172. All patients in the BR-NAC group underwent subsequent resection, as none showed disease progression or chemotherapy-associated liver damage. The 3- and 5-year overall survival rates of the CR-US group were 83.0% and 74.0%, while patients in the BR-NAC group had comparable 3-year and 5-year overall survivals (80.5% and 66.6%, P = 0.397).

Conclusion: Defining BR-CLM based on tumor characteristics optimizes patient selection for NAC. Favorable overall survival can be achieved by upfront surgery in patients with clearly resectable CLM and by NAC in patients with BR-CLM.

Keywords: Chemotherapy; Colorectal cancer; Liver metastases; Liver resection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Definition of resectability and the treatment strategies for CLM
Fig. 2
Fig. 2
Selection process for the CR-US, BR-NAC, and BR-US groups. *CLM during adjuvant chemotherapy of the primary tumor. **Unspecified preoperative chemotherapy at previous hospital
Fig. 3
Fig. 3
Long-term survival in the BR-NAC and CR-US groups. a Recurrence-free survival. b Overall survival. Survival curves were calculated from the date of chemotherapy initiation in the BR-NAC group and from the date of hepatic resection in the CR-US group
Fig. 4
Fig. 4
Patterns of recurrence after hepatic resection
See this image and copyright information in PMC

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