Published online Jul 15, 2022. doi: 10.4251/wjgo.v14.i7.1281
Peer-review started: February 1, 2022
First decision: April 17, 2022
Revised: April 29, 2022
Accepted: June 4, 2022
Article in press: June 4, 2022
Published online: July 15, 2022
Processing time: 161 Days and 20.5 Hours
Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. The liver is the most common metastatic site of CRC, and hepatectomy is the mainstay of treatment for patients with colorectal liver metastases (CRLMs). Upfront hepatectomy is recommended for patients with resectable CRLMs. However, there are cases of early recurrence after upfront hepatectomy alone in the resectable CRLMs. In selected patients, neoadjuvant chemotherapy (NAC) may improve long-term survival.
Identifying the poor prognostic factors for upfront hepatectomy in resectable CRLMs and investigating the effectiveness of NAC are urgently needed to improve long-term survival of patients with resectable CRLMs.
To determine the efficacy of NAC for initially resectable CRLMs.
Among 644 patients who underwent their first hepatectomy for CRLMs at our institution, 297 resectable cases were stratified into an upfront hepatectomy group (238 patients) and NAC group (59 patients). Poor prognostic factors for upfront hepatectomy were identified using multivariate logistic regression analysis. Propensity score matching was used, and clinical outcomes between the upfront hepatectomy and NAC groups were compared according to the number of poor prognostic factors. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test.
As independent poor prognostic factors for overall survival (OS) in the upfront hepatectomy group, preoperative carcinoembryonic antigen (CEA) levels (≥ 10 ng/mL) (P = 0.003), primary histological type (other than well/moderately differentiated) (P = 0.04), and primary lymph node metastases (≥ 1) (P = 0.04) were identified. High-risk status was defined as the presence of two or more risk factors. Fifty patients were matched in upfront hepatectomy and NAC groups respectively, after propensity score matching. Among high-risk patients, the 5-year OS rate was significantly higher in the NAC group (13 patients) than in the upfront hepatectomy group (18 patients) (100% vs 34%; P = 0.02).
NAC was effective in patients with resectable CRLMs who had at least two of the following risk factors: Preoperative CEA levels (≥ 10 ng/mL), primary histological type (other than well/moderately differentiated), and lymph node metastases (≥ 1).
NAC therapy may improve the prognosis of high-risk patients with resectable CRLMs.