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Multicenter Study
. 2024 Apr;9(4):102991.
doi: 10.1016/j.esmoop.2024.102991. Epub 2024 Apr 16.

Predicting early recurrence after resection of initially unresectable colorectal liver metastases: the role of baseline and pre-surgery clinical, radiological and molecular factors in a real-life multicentre experience

R Moretto  1 , M M Germani  2 , B Borelli  2 , V Conca  2 , D Rossini  3 , P Boraschi  4 , F Donati  4 , L Urbani  5 , S Lonardi  6 , F Bergamo  6 , K Cerma  6 , G Ramondo  7 , F E D'Amico  8 , L Salvatore  9 , G Valente  9 , B Barbaro  10 , F Giuliante  11 , M Di Maio  12 , G Masi  2 , C Cremolini  13
Affiliations
Multicenter Study

Predicting early recurrence after resection of initially unresectable colorectal liver metastases: the role of baseline and pre-surgery clinical, radiological and molecular factors in a real-life multicentre experience

R Moretto et al. ESMO Open. 2024 Apr.

Abstract

Background: Advances in surgical techniques and systemic treatments have increased the likelihood of achieving radical surgery and long-term survival in metastatic colorectal cancer (mCRC) patients with initially unresectable colorectal liver metastases (CRLMs). Nonetheless, roughly half of the patients resected after an upfront systemic therapy experience disease relapse within 6 months from surgery, thus leading to the question whether surgery is actually beneficial for these patients.

Materials and methods: A real-world dataset of mCRC patients with initially unresectable liver-limited disease treated with conversion chemotherapy followed by radical resection of CRLMs at three high-volume Italian institutions was retrospectively assessed with the aim of investigating the association of baseline and pre-surgical clinical, radiological and molecular factors with the risk of relapse within 6 or 12 months from surgery.

Results: Overall, 268 patients were included in the analysis and 207 (77%) experienced recurrence. Ninety-six (46%) of them had disease relapse within 6 months after CRLM resection and in spite of several variables associated with early recurrence at univariate analyses, only primary tumour resection at diagnosis [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.32-0.89, P = 0.02] remained significant in the multivariable model. Among patients with resected primary tumours, pN+ stage was associated with higher risk of disease relapse within 6 months (OR 3.02, 95% CI 1.23-7.41, P = 0.02). One hundred and forty-nine patients (72%) had disease relapse within 12 months after CRLMs resection but none of the analysed variables was independently associated with outcome.

Conclusions: Clinical, radiological and molecular factors assessed before and after conversion chemotherapy do not reliably predict early recurrence after secondary resection of initially unresectable CRLMs. While novel markers are needed to optimize the cost/efficacy balance of surgical procedures, CRLM resection should be offered as soon as metastases become resectable during first-line chemotherapy to all patients eligible for surgery.

Keywords: conversion chemotherapy; early disease recurrence; secondary resection; unresectable colorectal liver metastases.

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Figures

Figure 1
Figure 1
Patterns of disease recurrence. In the overall population (A) and according to timing of disease relapse, with cut-offs for early recurrence of 6 months (B) and 12 months (C).
Figure 2
Figure 2
Overall survival from disease relapse according to patterns of disease recurrence. CI, confidence interval; HR, hazard ratio.
See this image and copyright information in PMC

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