nach oben

Erschienen in:

06.03.2020 | Hepatobiliary Tumors

What is the Prognostic Value of a Discordant Radiologic and Pathologic Response in Patients Undergoing Resection of Colorectal Liver Metastases After Preoperative Chemotherapy?

verfasst von: Antoine Brouquet, MD, PhD, Christelle Blot, MD, Marc-Antoine Allard, MD, PhD, Thierry Lazure, MD, Mylène Sebbagh, MD, Mathilde Gayet, MD, Maïté Lewin, MD, René Adam, MD, Christophe Penna, MD, Antonio Sa Cunha, MD, PhD, Stephane Benoist, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

The clinical significance of discordant radiological and pathological response to preoperative chemotherapy of colorectal liver metastases (CLM) is unknown.

Methods

From 2011 to 2016, all eligible patients undergoing resection for CLM after preoperative chemotherapy were included at two centres. Patients were categorized according to radiologic response using RECIST as Rad-responders (complete/partial response) or Rad-non responders (stable disease) and according to Blazer et al. pathologic response grade as Path-responders (complete/major response) or Path-non responders (minor response). Survival outcome was analysed according to radiologic and pathologic response.

Results

Among 413 patients undergoing resection of CLM, 119 fulfilled the inclusion criteria. Among these, 52 (44%) had discordant radiologic and pathologic response including 27 Rad-non responders/path responders and 25 Rad-responders/Path-non responders. Rad-non responders/path responders and Rad-responders/Path-non responders had similar characteristics except for the proportion receiving more than 6 cycles of preoperative chemotherapy (7/27 vs 16/25; P = 0.017). Median disease-free survival was not different in patients with or without discordant radiologic and pathologic responses (P = 0.195) but the type of discordance had an impact on oncologic outcome as median disease-free survival was 13.9 months (95% CI 5.7–22.2 months) in Rad-non responders/Path responders and 8.6 (6.2 – 10.9 months) in Rad-responders/Path-non responders (P = 0.034). Univariate and multivariate analysis showed that major pathologic response was associated with improved disease-free survival (OR 0.583, 95% CI 0.36–0.95, P = 0.031).

Conclusion

A discordant radiologic and pathologic response is common after preoperative chemotherapy for CLM. In these patients, pathologic response drives oncologic outcome.

Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.CrossRef

Allen PJ, Kemeny N, Jarnagin W, et al. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–17.CrossRef

Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61 (discussion 1061–1064).CrossRef

Blazer DG, Kishi Y, Maru DM, et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol. 2008;26:5344–51.CrossRef

Rubbia-Brandt L, Giostra E, Brezault C, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304.CrossRef

Chun YS, Vauthey J-N, Boonsirikamchai P, et al. Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA. 2009;302:2338–44.CrossRef

Brouquet A, Zimmitti G, Kopetz S, et al. Multicenter validation study of pathologic response and tumor thickness at the tumor-normal liver interface as independent predictors of disease-free survival after preoperative chemotherapy and surgery for colorectal liver metastases. Cancer. 2013;119:2778–88.CrossRef

Berardi G, De Man M, Laurent S, et al. Radiologic and pathologic response to neoadjuvant chemotherapy predicts survival in patients undergoing the liver-first approach for synchronous colorectal liver metastases. Eur J Surg Oncol. 2018;44:1069–77.CrossRef

Viganò L, Capussotti L, Barroso E, et al. Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases. Ann Surg Oncol. 2012;19:2786–96.CrossRef

10.

Brouquet A, Nordlinger B. Neoadjuvant therapy of colorectal liver metastases: lessons learned from clinical trials. J Surg Oncol. 2010;102:932–6.CrossRef

11.

Benoist S, Brouquet A, Penna C, et al. Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol. 2006;24:3939–45.CrossRef

12.

Shindoh J, Loyer EM, Kopetz S, et al. Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases. J Clin Oncol. 2012;30:4566–72.CrossRef

13.

Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.CrossRef

14.

Hosseini-Nik H, Fischer SE, Moulton C-AE, et al. Diffusion-weighted and hepatobiliary phase gadoxetic acid-enhanced quantitative MR imaging for identification of complete pathologic response in colorectal liver metastases after preoperative chemotherapy. Abdom Radiol N Y. 2016;41:231–8.CrossRef

15.

Nishioka Y, Yoshioka R, Gonoi W, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography as an objective substitute for CT morphologic response criteria in patients undergoing chemotherapy for colorectal liver metastases. Abdom Radiol NY. 2018;43:1152–58.CrossRef

16.

de Gramont A, Van Cutsem E, Schmoll H-J, et al. Bevacizumab plus oxaliplatin-based chemotherapy as adjuvant treatment for colon cancer (AVANT): a phase 3 randomised controlled trial. Lancet Oncol. 2012;13:1225–33.CrossRef

17.

Primrose J, Falk S, Finch-Jones M, et al. Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis: the New EPOC randomised controlled trial. Lancet Oncol. 2014;15:601–11.CrossRef

Titel: What is the Prognostic Value of a Discordant Radiologic and Pathologic Response in Patients Undergoing Resection of Colorectal Liver Metastases After Preoperative Chemotherapy?
verfasst von: Antoine Brouquet, MD, PhD
Christelle Blot, MD
Marc-Antoine Allard, MD, PhD
Thierry Lazure, MD
Mylène Sebbagh, MD
Mathilde Gayet, MD
Maïté Lewin, MD
René Adam, MD
Christophe Penna, MD
Antonio Sa Cunha, MD, PhD
Stephane Benoist, MD, PhD
Publikationsdatum: 06.03.2020
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 8/2020
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-020-08284-1

Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial

Melanoma

Systemic Inflammation and Outcome in 2295 Patients with Stage I–III Colorectal Cancer from Scotland and Norway: First Results from the ScotScan Colorectal Cancer Group

Open Access
Colorectal Cancer

ASO Author Reflections: Discordant Pathologic and Radiologic Response of Colorectal Liver Metastases After Chemotherapy: Which One Should We Trust to Predict Outcome and to Tailor Postoperative Chemotherapy?

ASO Author Reflections

COVID-19 Data and the Cancer Patient: A Need for Registry Inclusion

Zur Zeit gratis
COVID-19
Health Services Research and Global Oncology

Time to Adjuvant Radiotherapy in Breast Cancer Affects Survival: Implications for the American College of Surgeons Commission on Cancer Quality Metrics

Health Services Research and Global Oncology

The Landmark Series: Intrahepatic Cholangiocarcinoma

Hepatobiliary Tumors

Neu im Fachgebiet Chirurgie

Nur selten ernste Komplikationen bei endoskopischer Sinuschirurgie

19.03.2025
Rhinosinusitis
Nachrichten

Etwa 3% der Menschen mit einer endoskopischen Nasennebenhöhlenoperation entwickeln ausgeprägtes Nasenbluten. Andere Komplikationen, wie Verletzungen des Nervus opticus oder eine Meningitis, treten nur äußerst selten auf, legt eine Registeranalyse nahe.

Hochrisiko-Spinaliom am besten mit der Mohs-Chirurgie entfernen

18.03.2025
Plattenepithelkarzinom der Haut
Nachrichten

Die Mohs-Chirurgie ist zwar mit mehr Aufwand verbunden als die herkömmliche Exzision; für die Versorgung kutaner Hochrisiko-Plattenepithelkarzinome lohnt sich die zeitintensive Technik aber in jedem Fall. Laut einer aktuellen Studie sinkt im Vergleich das Sterberisiko.

Mechanische Herzklappe beschert jüngeren Betroffenen längeres Leben

17.03.2025
Herzklappenersatz
Nachrichten

Patienten und Patientinnen bevorzugen bioprothetische Herzklappen gegenüber mechanischen Klappenprothesen. Diese Wahl könnte sich zumindest für jüngere Patienten nachteilig auswirken: Ihnen bietet eine mechanische Klappe anscheinend einen Überlebensvorteil.

Darmpolyp weg – Peptid-Gel gegen Nachblutungen drauf?

17.03.2025
Darmpolypen
Nachrichten

Das Nachblutungsrisiko nach einer endoskopischen Mukosaresektion von flachen kolorektalen und duodenalen Adenomen war in der deutschen PURPLE-Studie mit einem hämostatischen Gel nicht kleiner als ohne Prophylaxe.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

What is the Prognostic Value of a Discordant Radiologic and Pathologic Response in Patients Undergoing Resection of Colorectal Liver Metastases After Preoperative Chemotherapy?