Erschienen in:
19.03.2018 | Hepatobiliary Tumors
Progression of Colorectal Cancer Liver Metastasis After Chemotherapy: A New Test of Time?
verfasst von:
Eve Simoneau, MD, PhD, FRCSC, Jean-Nicolas Vauthey, MD, FACS
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 6/2018
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Excerpt
With the increasing use of chemotherapy prior to resection for colorectal liver metastases (CLM), progression on treatment has been used at some hepatobiliary centers as a criterion to determine whether resection was justified. In 2004, Adam et al. reported the outcomes of patients exhibiting disease progression during preoperative chemotherapy in a series of 131 resected patients with ≥ 4 metastases and showed 5-year survival of only 8% for this subgroup.
1 This led to the conclusion that disease progression during preoperative chemotherapy may represent a contraindication to resection due to lack of survival benefit. Subsequently, the same authors later softened their recommendations and showed in a series using LiverMetSurvey data
2 that disease progression only, although a negative prognostic factor, was associated with 5-year survival of 53%. In that study of 2146 patients of whom 8% (
n = 176) progressed during preoperative chemotherapy, presence of additional prognostic factors [size > 50 mm, > 3 lesions, carcinoembryonic antigen (CEA) > 200 ng/mL] contributed to adverse outcomes in that subset of patients, with high CEA being independently associated with worse outcome [relative risk (RR) 5.06 (1.72–14.95),
p = 0.003] with 10% 3-year overall survival. …
