Pathologic response after preoperative therapy predicts prognosis of Chinese colorectal cancer patients with liver metastases

Abstract

BackgroundPathologic response is evaluated according to the extent of tumor regression and is used to estimate the efficacy of preoperative treatment. Several studies have reported the association between the pathologic response and clinical outcomes of colorectal cancer patients with liver metastases who underwent hepatectomy. However, to date, no data from Chinese patients have been reported. In this study, we aimed to evaluate the association between the pathologic response to pre-hepatectomy chemotherapy and prognosis in a cohort of Chinese patients.Patients and methodsIn this retrospective study, we analyzed the data of 380 liver metastases in 159 patients. The pathologic response was evaluated according to the tumor regression grade (TRG). The prognostic role of pathologic response in recurrence-free survival (RFS) and overall survival (OS) was assessed using Kaplan–Meier curves with the log-rank test and multivariate Cox models. Factors that had potential influence on pathologic response were also analyzed using multivariate logistic regression and Kruskal–Wallis/Mann–Whitney U tests.ResultsPatients whose tumors achieved pathologic response after preoperative chemotherapy had significant longer RFS and OS than patients whose tumor had no pathologic response to chemotherapy (median RFS: 9.9 vs. 6.5 months, P = 0.009; median OS: 40.7 vs. 28.1 months, P = 0.040). Multivariate logistic regression and Kruskal–Wallis/Mann–Whitney U tests showed that metastases with small diameter, metastases from the left-side primary tumors, and metastases from patients receiving long-duration chemotherapy had higher pathologic response rates than their control metastases (all P < 0.05). A decrease in the serum carcinoembryonic antigen (CEA) level after preoperative chemotherapy predicted an increased pathologic response rate (P < 0.05). Although the application of targeted therapy did not significantly influence TRG scores of all cases of metastases, the addition of cetuximab to chemotherapy resulted in a higher pathologic response rate when combined with irinotecan-based regimens rather than with oxaliplatin-based regimens.ConclusionsWe found that the evaluation of pathologic response may predict the prognosis of Chinese colorectal cancer patients with liver metastases after preoperative chemotherapy. Small tumor diameter, long-duration chemotherapy, left primary tumor, and decreased serum CEA level after chemotherapy are associated with increased pathologic response rates.

Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases

“…In contrast, left‐sided tumours harbour chromosomal instability and CMS2 more often. Therapeutically, CRLMs from right‐sided primary tumours tend to have a lower response rate to preoperative chemotherapy than left‐sided tumours. On the other hand, although repeat hepatectomy has become a critical strategy for recurrent CRLM, patients with right‐sided tumours frequently experience disease recurrence with more advanced and unsalvageable disease, such as the presence of multiple recurrent lesions or EHD.…”

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Histological tumor response assessment in colorectal liver metastases after neoadjuvant chemotherapy: impact of the variation in tumor regression grading and peritumoral lymphocytic infiltration

“…These findings underline that considerable variations seem to exist in colorectal liver metastases and that its potential relationship to tumor response should not be neglected. Previous studies have confirmed that the tumor size, duration of perioperative chemotherapy, serum CEA level and preoperative chemotherapy regimens are efficient predictors of pathological response 19, 29. We speculate that tumor heterogeneity, manifesting differences in metastatic tumor burden and chemotherapy sensitivity, exists among liver metastases and results in pronounced discrepancies in TRG scores in the same patient after NACT.…”

Development of a model to predict pathologic response to chemotherapy in patients with colorectal liver metastases

“…Primary tumor location was also an important factor for chemotherapy response. Serayssol et al and Wang et al found that it was associated with poor pathologic response (11,12). However, other studies did not find similar results.…”