Survival Following Liver Transplantation for Patients With Nonresectable Liver-only Colorectal Metastases

Abstract

Objective: To determine overall survival and disease-free survival in selected patients with nonresectable liver-only colorectal cancer receiving liver transplantation. Background: Patients with nonresectable colorectal cancer receiving palliative chemotherapy has a 5-year overall survival of about 10%. Liver transplantation provided an overall survival of 60% in a previous study (SECA-I). Risk factors for death were carcinoembryonic antigen (CEA) >80 μg/L, progressive disease on chemotherapy, size of largest lesion>5.5 cm, and less than 2 years from resection of the primary tumor to transplantation. Methods: In this prospective (SECA-II) study, we included colorectal cancer patients with nonresectable liver-only metastases determined by computed tomography (CT)/magnetic resonance imaging/positron emission tomography scans and at least 10% response to chemotherapy. Time from diagnosis to liver transplant was required to be more than 1 year. Results: At a median follow-up of 36 months, Kaplan-Meier overall survival at 1, 3, and 5 years were 100%, 83%, and 83%, respectively. Disease-free survival at 1, 2, and 3 years were 53%, 44%, and 35%, respectively. Overall survival from time of relapse at 1, 2, and 4 years were 100%, 73%, and 73%, respectively. Recurrence was mainly slow growing pulmonary metastases amenable to curative resection. Fong Clinical Risk Score of 1 to 2 at the time of diagnosis resulted in longer disease-free survival than score 3 to 4 (P = 0.044). Patients included in the present study had significantly better prognostic factors than the previous SECA-I study. Conclusion: Liver transplantation provides the longest overall survival reported in colorectal cancer patient with nonresectable liver metastases. Improved selection criteria give patients with nonresectable colorectal liver metastases a 5-year overall survival comparable to other indications for liver transplantation.

Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis

“…Similarly, a scoring system based on morphology of liver lesions and factors like CEA may be used for selecting patients with CRLM for LT to obtain long OS. 13,15 The majority of the patients experienced a relapse; however, in contrast to HCC with recurrence, the CRC cohort had a long OS from the time of relapse, 22 2B, and 3B). The tradeoff in applying very stringent criteria is obviously that few patients will be eligible.…”

“…The immunosuppression protocol consisted of induction with basiliximab, sirolimus (mTOR inhibitor), or tacrolimus the first 4 to 6 weeks and then conversion to sirolimus (SECA-II study). 15…”

“…[5][6][7][8][9] Liver transplant (LT) is the standard of care for selected patients with malignant liver tumors such as hepatocellular carcinoma (HCC) and liver metastases from low-grade neuroendocrine tumors. 15 The aim of the present study was to investigate how 3 different clinical scoring systems could predict long-term survival after LT of patients with CRC with nonresectable liver only metastases. 12 In 2006, we started a pilot study (SECA-I) reexamining LT in patients with CRC with nonresectable liver-only metastases.…”

“…We used 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) in combination with computed tomography (CT) to exclude extrahepatic metastases; further, patients with high liver PET uptake had reduced 5-year OS after LT. 14 We showed elsewhere that patients with response to chemotherapy, lower CEA levels at time of LT, and smaller and fewer liver metastases have a Kaplan-Meier (KM)-estimated 5-year OS of 83%. 15 The aim of the present study was to investigate how 3 different clinical scoring systems could predict long-term survival after LT of patients with CRC with nonresectable liver only metastases.…”

Two‐Stage Recipient Hepatectomy and Left Liver Transplantation to Minimize Risks in Adult‐to‐Adult Living Donor Liver Transplantation: New Concepts

“…First, all articles concentrate on colorectal cancer liver metastases. (2,3,8) Nonetheless, the concept can be extended to neuroendocrine tumors and hepatocarcinoma in patients without significant portal hypertension and with a favorable liver anatomy.…”