Influence of neoadjuvant chemotherapy on resection of primary colorectal liver metastases: A propensity score analysis

Strowitzki, Moritz J.; Schmidt, Thomas; Keppler, Ulrich; Ritter, Alina S.; Mahmoud, Sarah; Klose, Johannes; Mihaljevic, André L.; Schneider, Martin; Büchler, Markus W.; Ulrich, Alexis

doi:10.1002/jso.24631

Cited by 21 publications

(19 citation statements)

References 39 publications

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“…Several studies showed that there was no significant difference regarding survival between patients receiving simultaneous resections and staged resections [10,25]. This was also identified in a recent study [26]. In this study, the OS and RFS of patients undergoing simultaneous resection and staged resection did not differ significantly, and the OS was superior to that reported in those receiving palliative chemotherapy.…”

Section: Discussionsupporting

confidence: 75%

Comparison of sequential, delayed and simultaneous resection strategies for synchronous colorectal liver metastases

Wang

Jin

et al. 2020

BMC Surg

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Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P = 0.166). The overall survival at 1 and 3 years in the SeR group (93.9 and 50.1%) was lower than that in the DeR group (94.9 and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0 and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4 and 18.4%) was lower than that in the DeR group (43.9 and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4 and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases > 30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

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Section: Discussionsupporting

confidence: 75%

Comparison of sequential, delayed and simultaneous resection strategies for synchronous colorectal liver metastases

Wang

Jin

et al. 2020

BMC Surg

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“…Strowitzki et al . showed that even in a total of 468 patients with colorectal liver metastases the administration of neoadjuvant chemotherapy is of questionable value 17 .…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer

Lee

Park

Lee

et al. 2019

Sci Rep

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To date, the effect of adjuvant chemotherapy after curative resection in patients with stage II colon cancer remains controversial. Still, little is known about the effects of adjuvant chemotherapy in patients with stage II colon cancer who are older than 70 years, as most studies did not focus on this population. This study aimed to investigate the oncologic outcomes of elderly patients with stage II colon cancer who underwent curative resection with or without postoperative adjuvant chemotherapy. We retrospectively reviewed medical records of patients older than 70 years who underwent curative resection of stage II primary colon cancer during 2002–2015. Patients were classified into surgery alone (SA) and adjuvant chemotherapy (AC) groups and propensity score-matched at a 1:1 ratio using a logistic regression. The end points were recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). Of the 623 patients who met the criteria, 145 were assigned to each arm after propensity score matching. The mean ages of the SA and AC groups were 74.3 and 74.0 years, respectively. A log-rank test revealed no significant inter-group differences in RFS (p = 0.202), CSS (p = 0.486) or OS (p = 0.299). In a Cox regression analysis, adjuvant chemotherapy was not found to be an independent factor affecting RFS (p = 0.206), CSS (p = 0.487) or OS (p = 0.301). Adjuvant chemotherapy does not appear to yield survival benefits in elderly patients with stage II colon cancer.

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“…Complications were separated into intra- and postoperative complications (such as severe bleeding or bile leakage) and non-surgical complications. 3 …”

Section: Methodsmentioning

confidence: 99%

“… 1 , 2 However, chemotherapy-induced liver damage and associated effects on oncologic outcomes need to be considered. 3 – 6 Chemotherapy-associated liver injury, such as hepatic steatosis, steatohepatitis and sinusoidal obstruction syndrome, occurs in up to 50% of patients receiving neoadjuvant chemotherapy (NC). 7 Negative effects of NC on hepatic functional reserve seem to be regimen-specific.…”

Section: Introductionmentioning

confidence: 99%

High hepatic expression of PDK4 improves survival upon multimodal treatment of colorectal liver metastases

et al. 2019

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BACKGROUND: Patients with borderline resectable colorectal liver metastases (CRLM) frequently receive neoadjuvant chemotherapy (NC) to reduce tumour burden, thus making surgical resection feasible. Even though NC can induce severe liver injury, most studies investigating tissue-based prognostic markers focus on tumour tissue. Here, we assessed the prognostic significance of pyruvate-dehydrogenase-kinase isoenzyme 4 (PDK4) within liver tissue of patients undergoing surgical resection due to CRLM. METHODS: Transcript levels of hypoxia-adaptive genes (such as PDK isoenzymes) were assessed in the tissue of healthy liver, corresponding CRLM, healthy colon mucosa and corresponding tumour. Uni-and multivariate analyses were performed. Responses to chemotherapy upon up-or down-regulation of PDK4 were studied in vitro. RESULTS: PDK4 expression within healthy liver tissue was associated with increased overall survival and liver function following surgical resection of CRLM. This association was enhanced in patients with NC. PDK4 expression in CRLM tissue did not correlate with overall survival. Up-regulation of PDK4 increased the resistance of hepatocytes and colon cancer cells against chemotherapyinduced toxicity, whereas knockdown of PDK4 enhanced chemotherapy-associated cell damage. CONCLUSION: Our findings suggest that up-regulated PDK4 expression reduces hepatic chemotherapy-induced oxidative stress and is associated with improved postoperative liver function in patients undergoing multimodal treatment and resection of CRLM.

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Influence of neoadjuvant chemotherapy on resection of primary colorectal liver metastases: A propensity score analysis

Abstract: NC was not associated with increased OS in patients suffering from CRLM. Additionally, potentially harmful chemotherapy prior to surgery increases the risk of postoperative complications in these patients.

Cited by 21 publications

References 39 publications

Comparison of sequential, delayed and simultaneous resection strategies for synchronous colorectal liver metastases

Comparison of sequential, delayed and simultaneous resection strategies for synchronous colorectal liver metastases

Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer

High hepatic expression of PDK4 improves survival upon multimodal treatment of colorectal liver metastases

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