Impact of homogeneous pathologic response to preoperative chemotherapy in patients with multiple colorectal liver metastases

Table 1 Details of the Rubbia-Brandt and MD Anderson classifications

The Rubbia-Brandt classification	The MD Anderson classification
TRG1: Absence of residual cancer and large amount of fibrosis	Complete response: No residual cancer cells
TRG2: Rare residual cancer cells scattered throughout the fibrosis	Major response: 1%-49% of residual cancer cells
TRG3: More residual tumor cells but fibrosis predominates	Minor response: More than 50% of residual cancer cells
TRG4: Residual cancer cells predominate over fibrosis
TRG5: No signs of regression.

TRG: Tumor regression grade.

Table 2 Characteristics of the study population n (%)

Variable	Study population
Demographic data
Male gender	45 (61)
Age, median (range), yr	62.5 (40-80)
body mass index, mean ± SD, kg/m2	25.36 ± 4.42
Tumor markers
CEA level, mean ± SD (mg/L)	17 ± 3.5
Ca 19.9 level, mean ± SD (UI/L)	23 ± 5.2
Primary tumor site
Ascending colon	10 (14)
Transverse colon	5 (7)
Descending colon	33 (45)
Rectum	25 (34)
Liver metastases
Median (range) number of preoperative LM	3 (1-14)
Synchronous LM	55 (75)
Surgical procedure
Right hepatectomy	15 (16)
Left lobectomy	4 (4)
Right lobectomy	3 (3)
Posterior segmentectomy	8 (11)
Wedge	58 (66)
Two-stage hepatectomy	15 (17)
Site of the 300 metastases (%)
I	2.5
II	10
III	17.5
IV	11
V	16
VI	20
VII	13
VIII	10
Preoperative chemotherapy
Regimen
Folfox	28 (32)
Folfiri/Folfox and bevacizumab	28 (32)
Folfiri with or without cetuximab	8 (9)
Campto or folfiri with or without cetuximab	20 (23)
Folfirinox	4 (4)
Median (range) number of preoperative cycles	12 (4-38)
Pathology
T stage
2	7 (9)
3	56 (77)
4	10 (14)
N stage
0	18 (24)
1	37 (51)
2	11 (15)
X	7 (10)
Median (range) size of metastases, cm	3.1 (0.2-5)
PRPC
Rubbia-Brandt classification
Major response	13 (15)
Partial response	12 (14)
Absence of response	63 (71)
MD Anderson classification
Complete response	8 (9)
Major response	26 (30)
Minor response	54 (61)

Table 3 Univariate and multivariate analyses of factors associated with a homogeneous pathologic response to preoperative chemotherapy

Variable	Homogeneity (Rubbia-Brandt)				Homogeneity (MD - Anderson)
	Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis
	OR [95%CI]	P value	OR [95%CI]	P value	OR [95%CI]	P value	OR [95%CI]	P value
Age	2.33 [0.89-6.07]	0.82	/	/	1.5 [0.61-3.67]	0.37	/	/
Gender	1 [0.48-2.09]	0.99	/	/	1 [0.48-2.09]	0.99	/	/
Hypertension	1.13 [0.43-2.92]	0.81	/	/	1.13 [0.43-2.92]	0.81	/	/
Body mass index	0.99 [0.98-1.02]	0.95	/	/	1.01 [0.98-1.03]	0.86	/	/
Rectal cancer	1.14 [0.56-2.34]	0.72	/	/	1.73 [0.82-3.63]	0.15	/	/
Number of peroperative LM	0.96 [0.86-1.07]	0.45	/	/	0.99 [0.89-1.10]	0.87	/	/
Time interval between chemotherapy and surgery	3 [0.31-28.84]	0.34	/	/	1.5 [0.53-4.21]	0.44	/	/
Folfiri-based chemotherapy	0.007 [0.09-0.6]	0.90			0.8 [0.3-2.0]	0.60
Metachronous liver metastases	2.11 [0.96-4.67]	0.14	2.8 [0.92-8.5]	0.06	1.33 [0.63-2.82]	0.45	/	/
T stage	1.26 [0.73-2.18]	0.41	/	/	1.17 [0.68-2.01]	0.58	/	/
N0 stage	0.8 [0.22-2.98]	0.74	/	/	0.8 [0.22-2.98]	0.74	/	/
ASA score	1.05 [0.88-1.25]	0.62	/	/	1.05 [0.88-1.26]	0.56	/	/
MSI	1.9 [0.2-18.3]	0.90			1.5 [0.2-9.8]	0.60
RAS status	1.05 [0.0-99]	0.90			4.5 [0.8-23.9]	0.30
Braf mutation	1.6 [0.0-120]	0.90			3.3 [0.32-34.6]	0.30
Use of bevacizumab	3.20 [1.17-8.74]	0.02	3.5 [1.2-10.5]	0.02	1.33 [0.56-3.16]	0.51	/	/
Metastases in the left lobe of the liver	0.67 [0.24-1.87]	0.44	/	/	0.67 [0.24-1.87]	0.44	/	/
Number chemotherapy cycles	1.79 [0.93- 3.44]	0.12	1.06 [0.97-1.1]	0.10	1.44 [0.76- 2.72]	0.27	/	/

LM: Liver metastases.