Predictive Value of Optimal Morphologic Response to First-Line Chemotherapy in Patients with Colorectal Liver Metastases

Abstract

Background: It has been reported that morphologic response to preoperative chemotherapy is an independent prognostic factor in patients who undergo hepatic resection of colorectal liver metastases (CLM). The aim of this study was to evaluate the predictive value of morphologic response to first-line chemotherapy in patients with CLM. Methods: We assessed 41 patients with CLM who received fluorouracil-based chemotherapy with or without bevacizumab as the first-line chemotherapy between April 2006 and June 2012. Three blinded radiologists evaluated computed tomography images and classified them as optimal, incomplete or no response according to the morphologic criteria. Response to systemic chemotherapy was also evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). Predictive factors associated with progression-free survival (PFS) were identified in multivariate analysis. Results: Twenty-three patients (56%) received chemotherapy with bevacizumab, while 18 patients (44%) received chemotherapy without bevacizumab. Optimal morphologic response was observed in 11 patients (48%) treated with bevacizumab and in 5 patients (28%) treated without bevacizumab (p = 0.19). Eight patients (20%) underwent hepatic resection after chemotherapy. The median follow-up period was 31.3 months. The median PFS was 13.3 months for patients with optical morphologic response and 8.7 months in those with incomplete/no morphologic response (p = 0.0026). On multivariate analysis, performance status and morphologic response were significant independent predictors of PFS. Conclusion: Optimal morphologic response was significantly associated with PFS in patients with CLM who were treated with fluorouracil-based chemotherapy as the first-line chemotherapy.

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

“…Assessing the response to preoperative treatment (chemotherapy with or without targeted agents) can be judged on tumour size [31,32], morphologic changes unrelated to size [33][34][35] and metabolic activity [36,37]. Change in size is a key indicator of response, but limitations encountered with the Response Evaluation Criteria In Solid Tumors (RECIST) have led investigators to explore alternative measures of the impact of chemotherapy on tumour size [38,39] and to define new parameters such as early tumour shrinkage and depth of response [40,41].…”

“…Change in size is a key indicator of response, but limitations encountered with the Response Evaluation Criteria In Solid Tumors (RECIST) have led investigators to explore alternative measures of the impact of chemotherapy on tumour size [38,39] and to define new parameters such as early tumour shrinkage and depth of response [40,41]. It has been shown that when treatment includes biological agents, such as bevacizumab, size is a poor predictor of outcome compared with non-size-based morphological criteria [35,34]. PET-CT is increasingly used to measure response in oncology, but its role when added to cross-sectional imaging to assess response in CRC metastases needs to be further explored [36,37].…”

Progress in New Diagnosis and Therapeutic Strategy for Gastrointestinal Malignancy: Focus on New Molecular-Targeted Treatments

“…This new evaluation system will provide a good prognostic factor for the response of patients with liver metastasis to therapy. These results were published in Digestion in 2014 [13]. Ohshima et al [unpubl.…”

“…UGT1A1 polymorphism was a prognostic factor for leukocytopenia due to the FOLFIRI-based regimen. Yoshita et al [13] presented a new system for evaluation of the optimal morphologic response of colorectal cancer patients with liver metastasis to chemotherapy. RECIST is a standard system for the evaluation of solid tumors worldwide.…”

“…Optimal response was defined as homogenous morphology and hypodensity with a thin, sharply defined shape according to Chun et al [14]. The PFS in the optimal-response group and the incomplete/no-response group is shown in figure 3[13]. This new evaluation system will provide a good prognostic factor for the response of patients with liver metastasis to therapy.…”