The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

Abstract

Background: The benefit of surgery in patients with non-colorectal non-neuroendocrine liver metastases (NCRN NELM) remains controversial. At the population level, several statistical prognostic factors and scores have been proposed but inconsistently verified. At the patient level, no selection criteria have been demonstrated to guide individual therapeutic decision making. We aimed to evaluate potential individual selection criteria to predict the benefit of surgery in patients undergoing treatment for NCRNNELM. Methods: Data for 114 patients undergoing surgery for NCRNNELM were reviewed. In this population, we identified an early relapse group (ER), defined as patients with unresectable recurrence < 1 year postoperatively who did not benefit from surgery (N = 28), and a long-term survival group (LTS), defined as patients who were recurrence-free ≥ 5 years postoperatively and benefited from surgery (N = 20). Clinicopathologic parameters, the Association Française de Chirurgie (AFC) score, and a modified 4-point Clinical Risk Score (mCRS) (excluding CEA level) were analyzed and compared between LTS and ER groups. Results: The majority of patients were female and a majority had an ASA score ≤ 2 at the time of liver surgery. The median age was 55 years. Almost half of the patients (46%) presented with a single-liver metastasis. Intermediateand low-risk AFC scores represented 40% and 60% of the population, respectively. Five-and 10-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 27%, and 30% and 12%, respectively. Negative prognostic factors were the size of liver metastases > 50 mm and delay between primary and NCRNNELM <24 months for OS and DFS, respectively. AFC score was not prognostic while high-risk mCRS (scores 3-4) was predictive for the poorer OS. The clinicopathologic parameters were similar in the ER and LTS groups, except the presence of N+ primary tumor, and the size of liver metastases was significantly higher in the ER group. Conclusion: In patients with resectable NCRNNELM, no predictive factors or scores were found to accurately preoperatively differentiate individual cases in whom surgery would be futile from those in whom surgery could be associated with a significant oncological benefit.

Histopathological growth pattern of liver metastases as an independent marker of metastatic behavior in different primary cancers

“…We confirmed the poor accuracy of traditional predictive and prognostic factors and scores in patients who underwent surgical resection of colorectal or non-colorectal LM ( 3 , 27 – 30 ). This indicates that classical markers, essentially relying on cancer stage and aggressiveness, such as the primary tumor stage, the mutational status, the kinetics and the extent of LM, are not sufficient to depict the overall tumor biology and to predict the type of metastatic progression.…”

Surgical treatment of liver metastases from non-colorectal non-neuroendocrine carcinomas

“…Multiple liver metastases were the third factor having a negative impact on 5-year survival. In our study, 41% of patients had solitary liver metastases; in the literature, the percentage varies between 46 and 62% (Bohlok et al 2020 ; Hoffmann et al 2015 ; Lendoire et al 2007 ; Sano et al 2018 ; Takemura et al 2013 ; Yedibela et al 2005 ).…”

“…A short interval between diagnosis of the primary tumor and liver metastases also resulted independently in poorer 5-year survival. We saw in 65% of patients a tumor free interval of less than 24 months, others saw 50% or 51% (Bohlok et al 2020 ; Holzner et al 2018 ; Slotta et al 2014 ).…”

“…These differences are mainly due to case mix in the studies. Patients with breast cancer were included in 5% (Sano et al ( 2018 ) to 61% (Bohlok et al ( 2020 ), but most studies do not provide detailed information on tumor sites. Some studies combine primaries of ovary, kidney, urinary bladder, ureter, testis, and prostate to “genitourinary cancer” (Bohlok et al 2020 ; Lendoire et al 2007 ; Schiergens et al 2016 ; Takemura et al 2013 ; Yedibela et al 2005 ).…”

Surgery for Liver Metastasis of Non-Colorectal and Non-Neuroendocrine Tumors

“…Adam et al shed light in 2006 on resection of NCRNNELM in a multicenter study including 1452 patients and developed an algorithm to assist selecting patients and predicting their outcomes [ 19 ]. This was a milestone in this field, yet a decade later, some of those factors might be outdated [ 20 ]. In their population, they identified an age of over 60 years, extrahepatic metastases, and major hepatectomy as negative prognostic factors.…”