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. 2023 Sep 1;158(9):e232932.
doi: 10.1001/jamasurg.2023.2932. Epub 2023 Sep 13.

Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant: A Nonrandomized Controlled Trial

Svein Dueland  1   2 , Tor Magnus Smedman  1   3   4 , Trygve Syversveen  5 , Harald Grut  6 , Morten Hagness  1   2 , Pål-Dag Line  1   2   4
Affiliations

Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant: A Nonrandomized Controlled Trial

Svein Dueland et al. JAMA Surg. .

Abstract

Importance: Liver transplant for colorectal cancer with liver metastases was abandoned in the 1990s due to poor overall survival. From 2006, liver transplant for in nonresectable colorectal liver metastases has been reexamined through different prospective trials.

Objective: To determine predictive factors for transplant long-term survival and cure after liver transplant.

Design, setting, and participants: This was a prospective, nonrandomized controlled cohort study derived from different clinical trials on liver transplant for colorectal liver metastases from 2006 to 2020 at Oslo University Hospital. The trials differed in prognostic inclusion criteria, but the design was otherwise identical regarding follow-up scheme to determine disease recurrence, overall survival, and survival after relapse. Final data analysis was performed on December 31, 2021. All patients with colorectal liver metastases from comparable prospective liver transplant studies were included.

Exposure: Liver transplant.

Main outcomes and measures: Disease-free survival, overall survival, and survival time after recurrence were determined in all participants.

Results: A total of 61 patients (median [range] age, 57.8 [28.7-71.1] years; 35 male [57.4%]) underwent liver transplant at Oslo University Hospital. Posttransplant observation time ranged from 16 to 165 months, and no patient was lost to follow-up. Median disease-free period, overall survival, and survival after relapse were 11.8 (95% CI, 9.3-14.2) months, 60.3 (95% CI, 44.3-76.4) months, and 37.1 (95% CI, 4.6-69.5) months, respectively. Negative predictive factors for overall survival included the following: largest tumor size greater than 5.5 cm (median OS, 25.3 months; 95% CI, 15.8-34.8 months; P <.001), progressive disease while receiving chemotherapy (median OS, 39.8 months; 95% CI, 28.8-50.7 months; P = .02), plasma carcinoembryonic antigen values greater than 80 μg/L (median OS, 26.6 months; 95% CI, 22.7-30.6 months; P <.001), liver metabolic tumor volume on positron emission tomography of greater than 70 cm3 (26.6 months; 95% CI, 11.8-41.5 months; P <.001), primary tumor in the ascending colon (17.9 months; 95% CI, 0-37.5 months; P <.001), tumor burden score of 9 or higher (23.3 months; 95% CI, 19.2-27.4 months; P = .02), and 9 or more liver lesions (42.5 months; 95% CI, 17.2-67.8 months; P = .02). An Oslo score of 0 or Fong Clinical Risk Score of 1 yielded 10-year survival of 88.9% and 80.0%, respectively.

Conclusions and relevance: Results of this nonrandomized controlled trial suggest that selected patients with liver-only metastases and favorable pretransplant prognostic scoring had long-term survival comparable with conventional indications for liver transplant, thus providing a potential curative treatment option in patients otherwise offered only palliative care.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dueland reported receiving grants from the Norwegian Cancer Society and South-Eastern Norway Regional Health Authority during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Disease-Free Survival, Overall Survival, and Survival After Relapse After Liver Transplant
A, Disease-free survival. B, Overall survival. C, Survival after relapse.
Figure 2.
Figure 2.. Association of Overall Survival After Liver Transplant With Oslo Score, Lesion Size, Treatment Response, Carcinoembryonic Antigen (CEA) Levels, and Time From Diagnosis
Association of overall survival after liver transplant with Oslo score (A), size of largest lesion (B), response to chemotherapy at time of transplant (C), CEA levels at time of transplant (D), and time from diagnosis to liver transplant (E).
Figure 3.
Figure 3.. Association of Overall Survival After Liver Transplant With Fong Clinical Risk Score (FCRS), Positron Emission Tomography (PET)–Metabolic Tumor Volume (MTV) Values, Tumor Location, and Liver Metastases
Overall survival associated with FCRS (A), PET-MTV values (B), location of primary tumor (C), and number of liver metastases (D).
See this image and copyright information in PMC

Comment in

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