Effect of Neoadjuvant Chemotherapy in Patients with Resectable Colorectal Liver Metastases

Abstract

BackgroundWhether patients with resectable colorectal liver metastases (CRLM) receive survival benefit from neoadjuvant chemotherapy remains controversial.MethodsWe retrospectively analyzed 466 patients with resectable CRLM between 2000 and 2010. Patient characteristics and survival data were recorded.ResultsThe patients were divided into one group with neoadjuvant chemotherapy (group NC, n = 121) and another without (group WN, n = 345). There was no difference in 5-year survival (52% vs. 48%) between the two groups. No significant differences were identified between the two groups in terms of 30-day mortality (1.7% vs. 1.2%) or morbidity (33.9% vs. 25.8%). A primary tumor at stage T4, ≥4 liver metastases, the largest liver metastasis ≥5 cm in diameter, and a serum CEA level ≥5 ng/ml were independent prognostic factors. By assigning one point to each, the patients were divided into a low-risk group (0–2) and a high-risk (3–4). The patients in the low-risk group received no survival benefit from neoadjuvant chemotherapy, whereas those in the high-risk group received survival benefit (5-year survival, 39% vs. 33%, P = 0.028).ConclusionsPreoperative neoadjuvant chemotherapy did not increase mortality or complications. Not all resectable patients, only those with >2 independent risk factors, received survival benefit from neoadjuvant chemotherapy.

The role of neoadjuvant chemotherapy for resectable colorectal liver metastases: a systematic review and meta-analysis

“…After independent review, 18,358 studies were excluded ether because they were not relevant to the current analysis or they were ineligibility based on the inclusion criteria (Figure 1). Ultimately, eighteen studies ( n = 6,254 patients) were included in this meta-analysis [11–28], among which four studies defined high risk factors for recurrence.…”

Neoadjuvant therapy of bevacizumab in combination with oxaliplatin and capecitabine (XELOX) for patients with metastatic colorectal cancer with unresectable liver metastases: a phase II, open‐label, single‐arm, noncomparative trial

“…28 Research shows that neoadjuvant chemotherapy can render unresectable liver metastases resectable in 10-35% of mCRC patients, 7,10,[29][30][31] with survival benefits in patients at high risk of mortality. 32 There is some indication that bevacizumab in combination with XELOX could improve outcomes in untreated mCRC patients, 33,34 especially those considered nonamenable for curative or R0 resection, 22,35 and could be safely administered as neoadjuvant therapy until 5 weeks prior to liver resection in patients with mCRC without increasing the rate of surgical or wound healing complications or severity of bleeding. 6 The use of systemic therapy to consequently achieve resectability offers a curative option, with long-term outcomes similar to those achieved with primary resection.…”

Chemotherapy in the Management of Localized and Metastatic Colon Cancer: New and Yet Unforgotten Approaches

“…У больных, имеющих одно-временно 3-4 фактора риска, 5-летняя общая выживае-мость составила 39% при использовании предопераци-онной химиотерапии и 33% в группе с только адъювант-ным лечением (р = 0,028). Таким образом, установлена позитивная роль предоперационной химиотерапии в группе больных с неблагоприятным прогнозом [12].…”