P-148 Recurrence free survival as a putative surrogate for overall survival in phase III Trials of Curative – Intent Treatment of Colorectal Liver Metastases: Systematic Review

ABSTRACT BACKGROUND: Liver metastases from colorectal cancer are an important public health problem due to the increasing incidence of colorectal cancer worldwide. Synchronous colorectal liver metastasis has been associated with worse survival, but this prognosis is controversial. OBJECTIVE: The objective of this study was to evaluate the recurrence-free survival and overall survival between groups of patients with metachronous and synchronous colorectal hepatic metastasis. METHODS: This was a retrospective analysis of medical records of patients with colorectal liver metastases seen from 2013 to 2016, divided into a metachronous and a synchronous group. The Cox regression model and the Kaplan-Meier method with log-rank test were used to compare survival between groups. RESULTS: The mean recurrence-free survival was 9.75 months and 50% at 1 year in the metachronous group and 19.73 months and 63.3% at 1 year in the synchronous group. The mean overall survival was 20.00 months and 6.2% at 3 years in the metachronous group and 30.39 months and 31.6% at 3 years in the synchronous group. Patients with metachronous hepatic metastasis presented worse overall survival in multivariate analysis. The use of biological drugs combined with chemotherapy was related to the best overall survival prognosis. CONCLUSION: Metachronous colorectal hepatic metastasis was associated with a worse prognosis for overall survival. There was no difference in recurrence-free survival between metachronous and synchronous metastases.

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How to reduce the risk of recurrence after surgical treatment of colorectal liver metastases?

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.544 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 544-544

Author(s):

L. Benhaim ◽

D. Goárá ◽

S. Bonnet ◽

F. Dumont ◽

D. Malka ◽

...

Keyword(s):

High Risk ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Systemic Chemotherapy ◽

Recurrence Free Survival ◽

Curative Intent ◽

Technical Problems ◽

Free Survival ◽

Hepatic Recurrence ◽

Liver Recurrence

544 Background: After surgery with curative intent for colorectal liver metastases (MHCCR), liver recurrence occurs in more than 60% of patients, despite the administration of adjuvant systemic chemotherapy. The objective of this study was to compare the prognosis of patients operated on MHCCR with high risk of recurrences in the liver, treated by postoperative chemotherapy hepatic arterial infusion (HAI) by oxaliplatin, to that obtained after adjuvant systemic chemotherapy. Methods: From January 2000 to December 2009, 113 patients who underwent curative resection of more than 3 MHCCR, were selected from a prospective database. Among these 113 patients, 47 had received postoperative HAI associated with systemic chemotherapy (HAI+) and 66, systemic chemotherapy alone (HAI-). Results: The two groups were comparable in age, sex, stage of primary, rates of synchronous (> 75%), and bilobar (> 90%) MHCCR. The number of MHCCR was significantly higher in the group HAI+ (p < 0.0001). Twenty-seven patients (57%) received more than 6 courses of HAI. HAI was discontinued in 6 patients (12%) due to technical problems with the catheter. After a median follow up of 75 months (7-125), the overall survival and recurrence-free survival at 5 years were higher for patients HAI+ compared to those HAI-, respectively 52.9% vs. 12.3% (p = 0.06) and 30.8% vs. 2% (p < 0.0001). Conclusions: The postoperative administration of oxaliplatin-based HAI associated to systemic chemotherapy after cure of MHCCR, improves recurrence-free survival of patients at high risk of hepatic recurrence, compared to systemic chemotherapy alone. No significant financial relationships to disclose.

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Two-stage hepatectomy for colorectal liver metastases: A multi-institutional retrospective review.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.351 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 351-351

Author(s):

Nicholas G Berger ◽

Bradford Kim ◽

Sepideh Gholami ◽

Georgios A Margonis ◽

Cecilia Ethun ◽

...

Keyword(s):

Overall Survival ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Recurrence Free Survival ◽

Short Term ◽

Two Stage ◽

Liver Remnant ◽

Free Survival ◽

Second Stage ◽

Major Complications

351 Background: A significant number of patients with colorectal liver metastases (CRLM) present with unresectable bilobar disease. Two-stage hepatectomy with portal vein embolization (PVE) have been described as a treatment for CRLM allowing for volume regeneration of a functional liver remnant. No large-scale multi-institutional studies exist. The aim of this project was to describe outcomes following two-stage hepatectomy, including overall survival (OS), recurrence-free survival (RFS), and complications. Methods: Patients completing two-stage hepatectomy for CRLM at five US institutions were identified and retrospectively analyzed (2000-2015). Overall survival and recurrence-free survival following second-stage surgery, short-term mortality, Clavien-Dindo complications, and readmission rates were examined. Results: A total of 209 patients were identified. Mean age was 52 (SD +/-11.4), 59.8% were male, and 87.0% had synchronous disease. A total of 65.1% of patients underwent PVE, and 27.3% underwent hepatic artery infusion pump placement. 88.3% of cases underwent neoadjuvant chemotherapy. Following the first stage, 30-day morbidity was 24.4%, with 4.8% major (Clavien-Dindo grade ≥3) complications, and 30-day readmission was 6.7%. Mean time between first and second stage was 4.1 months (S.D. +/-3.1), and 57.5% received systemic chemotherapy between the two resections. Following the second stage, overall complications were 47.4% with 23.9% major complications, and 30-day readmission was 9.7%. Mortality following second stage was 3.8% at 30 days, and 5.3% at 90-days. Following the second stage, RFS at 1-, 3-, and 5-years was 80%, 46%, and 29% respectively. OS at 1-, 3-, and 5-years was 87%, 64%, and 45% respectively. Conclusions: Two-stage hepatectomy for CRLM provides acceptable recurrence-free and overall survival in the context of advanced bilobar disease. Major complications and readmission following the first stage are rare. Following the second stage, short-term major morbidity, mortality, and readmissions are also acceptable. For well-selected patients, two-stage hepatectomy remains a safe and effective treatment for CRLM, with potential for more widespread adoption.

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Discrepancy Between Recurrence-Free Survival and Overall Survival in Patients with Resectable Colorectal Liver Metastases: A Potential Surrogate Endpoint for Time to Surgical Failure

Annals of Surgical Oncology ◽

10.1245/s10434-014-3504-1 ◽

2014 ◽

Vol 21 (6) ◽

pp. 1817-1824 ◽

Cited By ~ 41

Author(s):

Masaru Oba ◽

Kiyoshi Hasegawa ◽

Yutaka Matsuyama ◽

Junichi Shindoh ◽

Yoshihiro Mise ◽

...

Keyword(s):

Overall Survival ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Surrogate Endpoint ◽

Recurrence Free Survival ◽

Free Survival ◽

Surgical Failure

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Primary tumor location affects recurrence-free survival for patients with colorectal liver metastases after hepatectomy: A propensity score matching analysis

10.21203/rs.3.rs-16361/v2 ◽

2020 ◽

Author(s):

Yuanping Zhang ◽

Yongjin Wang ◽

Yichuan Yuan ◽

Jiliang Qiu ◽

Yuxiong Qiu ◽

...

Keyword(s):

Propensity Score ◽

Liver Metastases ◽

Primary Tumor ◽

Colorectal Liver Metastases ◽

Tumor Location ◽

Recurrence Free Survival ◽

Primary Tumors ◽

Free Survival ◽

Primary Tumor Location ◽

Before And After

Abstract Background: Whether primary tumor location of colorectal cancer (CRC) affects survival of patients after resection of liver metastases remains controversial. This study was conducted to investigate the differences in clinicopathological characteristics and prognosis between right-sided CRC and left-sided CRC patients with liver metastases after hepatectomy. Methods: From 2002 to 2018, 611 patients with colorectal liver metastases (CRLM) who underwent hepatectomy at our center were reviewed. Primary tumors located from cecum to transverse colon were defined as right-sided group (n = 141); tumors located from splenic flexure to rectum were defined as left-sided group (n = 470). Patients were compared between two groups before and after a 1:1 propensity score matching (PSM) analysis. Results: Before PSM, median survival time and 5-year overall survival (OS) rate in right-sided group were 77 months and 56.3%, and those in left-sided group were 64 months and 51.1%, respectively. After PSM, median survival time and 5-year OS rate in right-sided group were 77 months and 55.9%, and those in left-sided group were 58.8 months and 47.3%, respectively. The OS rates did not differ between two groups before and after PSM (P = 0.575; P = 0.453). However, significant different recurrence-free survival (RFS) rate was found before and after PSM between right-sided and left-sided group (P = 0.028, P = 0.003). Conclusions: Compared to patients with left-sided primary tumors, patients with right-sided primary tumors had a worse RFS but similar OS. Careful preoperative evaluation, intensive preoperative chemotherapy and frequent follow-up to detect early recurrence might be justified for CRLM patients with right-sided primary tumors.

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