Efficacy of neoadjuvant chemotherapy for initially resectable colorectal liver metastases: A retrospective cohort study

Abstract

BACKGROUND The liver is the most common metastatic site of colorectal cancer. Hepatectomy is the mainstay of treatment for patients with colorectal liver metastases (CRLMs). However, there are cases of early recurrence after upfront hepatectomy alone. In selected high-risk patients, neoadjuvant chemotherapy (NAC) may improve long-term survival. AIM To determine the efficacy of NAC for initially resectable CRLMs. METHODS 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 a NAC group (59 patients). Poor prognostic factors for upfront hepatectomy were identified using multivariate logistic regression analysis. Propensity score matching was used to compare clinical outcomes between the upfront hepatectomy and NAC groups, according to the number of poor prognostic factors. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. RESULTS Preoperative carcinoembryonic antigen 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 as independent poor prognostic factors for overall survival (OS) in the upfront hepatectomy group. High-risk status was defined as the presence of two or more risk factors. After propensity score matching, 50 patients were matched in each group. 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). CONCLUSION NAC may improve the prognosis of high-risk patients with resectable CRLMs who have two or more risk factors.

Meta-analysis of the prognostic value of serum carcinoembryonic antigen in patients with colorectal cancer liver metastases after hepatectomy

“…A total of 36 studies were included, involving 11 143 subjects, composed of 6769 men and 4374 women. Of these studies, 19 were from Asia (Sasaki et al , 2005; Tanaka et al , 2008; Yi et al ., 2013; Lu et al ., 2016; Okimoto et al ., 2017; Peng et al ., 2017; Wang et al ., 2017; Zhang et al ., 2017; Kawahara et al , 2018; Miki et al ., 2018; Chiang et al ., 2019; Kim et al ., 2019; Chen et al ., 2020; Meng et al , 2021; Ishii et al ., 2022; Takamizawa et al ., 2022; Takeda et al ., 2022; Yoshino et al ., 2022; Li et al ., 2023), 11 from Europe (Hohenberger et al , 1994; Gervaz et al , 2000; Pawlik et al ., 2005; Arru et al ., 2008; John et al ., 2013; Montalti et al ., 2015; Hof et al , 2016; Imai et al ., 2016; Peltonen et al , 2018; Polivka et al ., 2020; Kamphues et al ., 2021), 4 from North America (Reddy et al , 2009a,b; Sasaki et al ., 2016; Masuda et al ., 2018), and one study each from Oceania (Niu et al , 2007) and South America (Dumarco et al ., 2023). A total of 31 studies discussed pre-LR CEA levels, and 9 studies investigated the effect of post-LR CEA levels on prognosis in CRCLM patients.…”

“…A total of 28 studies (Hohenberger et al , 1994; Pawlik et al ., 2005; Sasaki et al , 2005; 2016; Arru et al ., 2008; Tanaka et al , 2008; Reddy et al , 2009a,b; John et al ., 2013; Montalti et al ., 2015; Lu et al ., 2016; Okimoto et al ., 2017; Peng et al ., 2017; Wang et al ., 2017; Zhang et al ., 2017; Masuda et al ., 2018; Peltonen et al , 2018; Kim et al ., 2019; Chen et al ., 2020; Polivka et al ., 2020; Kamphues et al ., 2021; Meng et al , 2021; Ishii et al ., 2022; Takamizawa et al ., 2022; Takeda et al ., 2022; Dumarco et al ., 2023; Li et al ., 2023) reported pre-LR serum CEA levels to predict OS in patients. The heterogeneity test results showed I 2 = 34.9%, so a fixed-effects model was used for analysis.…”

“…Of these 36 studies we included, a total of 28 studies (Hohenberger et al, 1994;Pawlik et al, 2005;Sasaki et al, 2005;Arru et al, 2008;Tanaka et al, 2008;Reddy et al, 2009a,b;John et al, 2013;Montalti et al, 2015;Lu et al, 2016;Okimoto et al, 2017;Peng et al, 2017;Wang et al, 2017;Zhang et al, 2017;Masuda et al, 2018;Peltonen et al, 2018;Kim et al, 2019;Chen et al, 2020;Polivka et al, 2020;Kamphues et al, 2021;Meng et al, 2021;Ishii et al, 2022;Takamizawa et al, 2022;Takeda et al, 2022;Dumarco et al, 2023;Li et al, 2023) reported pre-LR serum CEA levels to predict OS in patients, 4 studies (Miki et al, 2018;Peltonen et al, 2018;Polivka et al, 2020;Dumarco et al, 2023) reported to predict DFS in patients, 8 studies (Montalti et al, 2015;Peng et al, 2017;Wang et al, 2017;Kawahara et al, 2018;Ishii et al, 2022;Takamizawa et al, 2022;Yoshino et al, 2022;Li et al, 2023) reported predicting patient RFS. A total of 8 studies (Hohenberger et al, 1994;Gervaz et al, 2000;…”

“…Of these 36 studies we included, a total of 28 studies (Hohenberger et al , 1994; Pawlik et al ., 2005; Sasaki et al , 2005; 2016; Arru et al ., 2008; Tanaka et al , 2008; Reddy et al , 2009a,b; John et al ., 2013; Montalti et al ., 2015; Lu et al ., 2016; Okimoto et al ., 2017; Peng et al ., 2017; Wang et al ., 2017; Zhang et al ., 2017; Masuda et al ., 2018; Peltonen et al , 2018; Kim et al ., 2019; Chen et al ., 2020; Polivka et al ., 2020; Kamphues et al ., 2021; Meng et al , 2021; Ishii et al ., 2022; Takamizawa et al ., 2022; Takeda et al ., 2022; Dumarco et al ., 2023; Li et al ., 2023) reported pre-LR serum CEA levels to predict OS in patients, 4 studies (Miki et al ., 2018; Peltonen et al , 2018; Polivka et al ., 2020; Dumarco et al ., 2023) reported to predict DFS in patients, 8 studies (Montalti et al ., 2015; Peng et al ., 2017; Wang et al ., 2017; Kawahara et al , 2018; Ishii et al ., 2022; Takamizawa et al ., 2022; Yoshino et al ., 2022; Li et al ., 2023) reported predicting patient RFS. A total of 8 studies (Hohenberger et al , 1994; Gervaz et al , 2000; Niu et al , 2007; Hof et al , 2016; Imai et al ., 2016; Peltonen et al , 2018; Chiang et al ., 2019; Yoshino et al ., 2022) reported serum CEA levels that predicted OS in patients after LR, a total of 2 studies (Yi et al ., 2013; Peltonen et al , 2018) reported DFS in patients, and a total of 2 studies (Chiang et al ., 2019; Yoshino et al ., 2022) reported RFS in patients.…”