Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases

摘要

Purpose: Tumor progression while receiving neoadjuvant chemotherapy (PD) has been associated with poor outcome and is commonly considered a contraindication to liver resection (LR). This study aims to clarify in a large multicenter setting whether PD is always a contraindication to LR. Methods: Data from the LiverMetSurvey international registry were analyzed. Patients undergoing LR for colorectal metastases without extrahepatic disease after neoadjuvant chemotherapy between 1990 and 2009 were reviewed. Results: Among 2143 patients, PD occurred in 176 (8.2 %). Risk of progression was increased after 5-FU or irinotecan (22.7 % vs. 6.8 % after other regimens, p< 0.0001;14.9 % vs. 7.2 %, p< 0.0001), while it was reduced after oxaliplatin (5.6 % vs. 12.0 %, p <0.0001) and still diminished among patients receiving targeted therapies (2.6 %). PD was an independent prognostic factor of survival at multivariate analysis (35 % vs. 49 %, p = 0.0006). In the PD group, 3 independent prognostic factors were identified: carcinoembryonic antigen (CEA) ≥200 ng/mL (p = 0.003),>3 metastases (p = 0.028), and tumor diameter ≥50 mm (p = 0.002). A survival predictive model showed that patients without any risk factors had 5-year survival rates of 53.3 %; good survival results were still observed if metastases were>3 or ≥50 mm (29.9 and 19.1 %, respectively). On the contrary, survival was less than 10 % at 3 years in the presence of>1 prognostic factor or CEA of ≥200 ng/mL. Conclusions: PD is a negative prognostic factor, but it is not an absolute contraindication to LR. Patients with PD could be scheduled for LR except for those with >3 metastases and ≥50 mm, or CEA ≥200 ng/mL in whom further chemotherapy is recommended.