Resection of Colorectal Liver Metastases After Second-Line Chemotherapy: Is It Worthwhile? A LiverMetSurvey Analysis of 6415 Patients

• Autor(a) principal: Adam, R
• Data de Publicação: 2017
• Outros Autores: Yi, B, Innominato, PF, Barroso, E, Laurent, C, Giuliante, F, Capussotti, L, Lapointe, R, Regimbeau, JM, Lopez-Ben, S, Isoniemi, H, Hubert, C, Lin, JK, Gruenberger, T, Elias, D, Skipenko, OG, Guglielmi, A
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/2922
• topic: Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Catheter Ablation; Cetuximab; Disease Progression; Disease-Free Survival; Female; Hepatectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Postoperative Care; Preoperative Care; Prospective Studies; Registries; Colonic Neoplasms; Rectal Neoplasms; CHLC CHBPT

PURPOSE: Patient outcome after resection of colorectal liver metastases (CLM) following second-line preoperative chemotherapy (PCT) performed for insufficient response or toxicity of the first-line, is little known and has here been compared to the outcome following first-line. PATIENTS AND METHODS: From January 2005 to June 2013, 5624 and 791 consecutive patients of a prospective international cohort received 1 and 2 PCT lines before CLM resection (group 1 and 2, respectively). Survival and prognostic factors were analysed. RESULTS: After a mean follow-up of 30.1 months, there was no difference in survival from CLM diagnosis (median, 3-, and 5-year overall survival [OS]: 58.6 months, 76% and 49% in group 2 versus 58.9 months, 71% and 49% in group 1, respectively, P = 0.32). After hepatectomy, disease-free survival (DFS) was however shorter in group 2: 17.2 months, 27% and 15% versus 19.4 months, 32% and 23%, respectively (P = 0.001). Among the initially unresectable patients of group 1 and 2, no statistical difference in OS or DFS was observed. Independent predictors of worse OS in group 2 were positive primary lymph nodes, extrahepatic disease, tumour progression on second line, R2 resection and number of hepatectomies/year <50. Positive primary nodes, synchronous and bilateral metastases were predictors of shorter DFS. Initial unresectability did not impact OS or DFS in group 2. CONCLUSION: CLM resection following second-line PCT, after oncosurgically favourable selection, could bring similar OS compared to what observed after first-line. For initially unresectable patients, OS or DFS is comparable between first- and second-line PCT. Surgery should not be denied after the failure of first-line chemotherapy.