The authors used the multicenter international registry LiverMetSurvey to investigate whether progression of colorectal liver metastases while undergoing chemotherapy should be seen as a contraindication to liver resection. Tumor progression while receiving neoadjuvant chemotherapy has been associated with poor outcome and has been seen as a contraindication to liver resection previously. Patients undergoing liver resection for colorectal metastases without extrahepatic disease after neoadjuvant chemotherapy between 1990 and 2009 were reviewed. Among 2143 patients, progression on chemotherapy occurred in 176 (8.2 %). Risk of progression was increased after 5-FU or irinotecan (22.7 % vs. 6.8 %), while it was reduced after oxaliplatin (5.6 % vs. 12.0 %) and still diminished among patients receiving targeted therapies (2.6 %). Progression on chemotherapy was an independent prognostic factor of survival at multivariate analysis (35 % vs. 49 %, p = 0.0006). In the progression 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. In summary the authors concluded that while progression while on chemotherapy is a negative prognostic factor, it is not an absolute contraindication to liver resection.
Ann Surg Oncol 2012;19(9):2786-96
Headline: Progression on chemotherapy is not a contraindication to liver resection for colorectal metastases
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