scholarly journals The prognostic significance of a histological response to preoperative chemotherapy in patients with synchronous colorectal liver metastases

2021 ◽  
Author(s):  
Hideharu Tanaka ◽  
Hisashi Imai ◽  
Nobuhisa Matsuhashi ◽  
Toshiya Higashi ◽  
Shigeru Kiyama ◽  
...  
Keyword(s):  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Prognostic Significance ◽  
University Hospital ◽  
Remnant Liver ◽  
Histological Response ◽  
Free Survival ◽  
Initial Hepatectomy ◽  
Background Data ◽  
Synchronous Colorectal Liver Metastases

Objective: Preoperative chemotherapy (PC) for colorectal liver metastasis (CRLM) is widely used to improve prognosis, but its clinical benefit has not been fully established. This study aimed to assess the effectiveness of PC for synchronous CRLM and the correlation between the histological response to PC and survival. Summary of Background Data: We enrolled 69 patients who underwent initial hepatectomy for synchronous CRLM between 2004 and 2018 at Gifu University Hospital. Methods: We retrospectively analyzed the clinicopathological factors and outcomes of 69 patients who underwent hepatectomy after receiving PC (PC group: n = 43) or who underwent upfront hepatectomy (non-PC group: n = 26). In the PC group, the patients were divided into the Grade 1 (n = 27) and Grade 2/3 (n = 16) groups according to their histological responses to PC. Results: The median survival and 5-year overall survival (OS) rates were 80.9 months and 61.5%, respectively, in the PC group and 71.7 months and 61.5%, respectively, in the non-PC group ( P = 0.867). Regarding recurrence-free survival (RFS) and remnant liver-RFS, there were no significant differences between the two groups ( P = 0.087 and 0.291). However, in a subgroup analysis, the median 5-year OS, RFS, and remnant liver RFS were significantly longer in the Grade 2/3 than Grade 1 group ( P = 0.008, P = 0.002, and P < 0.001, respectively). Conclusions: Some patients benefit from PC, and the histological response to PC had prognostic significance for patients with synchronous CRLM.

scholarly journals The prognostic significance of a histological response to preoperative chemotherapy in patients with synchronous colorectal liver metastases

2021 ◽  
Author(s):  
Hideharu Tanaka ◽  
Nobuhisa Matsuhashi ◽  
Hisashi Imai ◽  
Toshiya Higashi ◽  
Shigeru Kiyama ◽  
...  
Keyword(s):  
Preoperative Chemotherapy ◽  
Prognostic Significance ◽  
Surgical Margin ◽  
Remnant Liver ◽  
Histological Response ◽  
Free Survival ◽  
Liver Recurrence ◽  
Initial Hepatectomy ◽  
Synchronous Colorectal Liver Metastases ◽  
Margin Positive

Abstract Background Preoperative chemotherapy (PC) for colorectal liver metastasis (CRLM) is widely used to improve prognosis, but its clinical benefit has not been fully established. This study aimed to assess the effectiveness of PC for synchronous CRLMs, and to analyze the correlation between histological response to PC and survival. Methods We retrospectively analyzed the clinicopathological factors and outcomes of 69 patients who underwent initial hepatectomy for synchronous CRLM between 2004 and 2018 after receiving PC (PC group: n = 43) or who underwent upfront hepatectomy without PC (Non-PC group: n = 26). In the PC group, the patients were divided into two groups, Grade 1 (n = 27) and Grade 2/3 (n = 16) groups according to their histological responses to PC. Results The median survival and 5-year overall survival (OS) rates were 80.9 months and 61.5%, respectively, in the PC group and 71.7 months and 61.5%, respectively, in the Non-PC group (P = 0.867). Regarding recurrence-free survival (RFS) and remnant liver-RFS, there were no significant differences between the two groups (P = 0.087 and 0.291). However, in a subgroup analysis according to the histological response to PC, the median 5-year OS, RFS, and remnant liver-RFS in the Grade 2/3 group were significantly longer than in the Grade 1 group (OS: 66 vs. 53 months; P = 0.008, RFS: 15 vs. 6.7 months; P = 0.002, remnant liver-RFS: 62 vs. 8.3 months; P < 0.001). Surgical margin positive status (< 1 mm) was associated with a high remnant liver recurrence rate (hazard ratio 2.597, P = 0.008). Conclusion PC should not be routinely administered to all patients with synchronous CRLMs. However, some patients benefit from PC, and the histological response to PC had prognostic significance for patients with synchronous CRLM.

scholarly journals Preoperative Chemotherapy on Functional Liver Regeneration for Colorectal Liver Metastases Assessed With 99mTc-GSA SPECT/CT Imaging

2018 ◽  
Vol 102 (9-10) ◽  
pp. 431-439 ◽  
Author(s):  
Toru Beppu ◽  
Hiromitsu Hayashi ◽  
Morikatsu Yoshida ◽  
Hidetoshi Nitta ◽  
Katsunori Imai ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Liver Regeneration ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Major Hepatectomy ◽  
Liver Volume ◽  
Control Group ◽  
Remnant Liver ◽  
Resection Rate

Objective: To investigate the functional liver regeneration after chemotherapy and liver resection for colorectal liver metastases (CRLM). Background/Purpose: Preoperative chemotherapy followed by liver resection for CRLM has been increasing; however, its negative impact on liver regeneration remains unknown. Methods: From January 2009 to December 2013, we enrolled 40 selected patients who underwent major hepatectomy without viral hepatitis and severe liver fibrosis. CRLM patients with preoperative chemotherapy (CT-CRLM group, n = 12) and patients without preoperative chemotherapy (control group, n = 28) were evaluated. Liver volume (LV) and functional liver volume (FLV) was assessed using Tc-99m–labeled galactosyl human serum albumin (99mTc-GSA) scintigraphy, single-photon emission computed tomography (SPECT), CT-fused images. Preoperative, future remnant liver, and post 1-month values were compared. Results: Median course of preoperative chemotherapy was 8 (range: 6–16). Preoperative background factors were almost identical including resection rate and functional resection rate. In the CT-CRLM group and in the control group, the percentage increases in LV were 39.3% ± 29.0% and 23.2% ± 23.5% (P = 0.037), and FLV were 79.4% ± 43.1% and 57.0% ± 33.4% (P = 0.417), respectively; absolute differences in LV were 216.2 ± 155.7 cm3 and 148.7 ± 134.7 cm3 (P = 0.086) and FLV were 19.4% ± 8.5%/m2 and 17.4% ± 7.9%/m2 (P = 0.235), respectively. We found no obvious tendency for negative influence on liver functional regeneration by the preoperative regimens for CRLM. Conclusions: Several courses of preoperative chemotherapy may not affect functional liver regeneration for CRLM patients after major hepatectomy.

scholarly journals Lymphopenia associated with adjuvant chemotherapy after potentially curative surgery for colorectal cancer correlates with recurrence

2016 ◽  
Author(s):  
Masatsune Shibutani ◽  
Kiyoshi Maeda ◽  
Hisashi Nagahara ◽  
Hiroshi Ohtani ◽  
Tetsuro Ikeya ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Lymphocyte Count ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Curative Surgery ◽  
Free Survival ◽  
Background Data ◽  
Disease Free

Abstract Objective: The aim of this retrospective study was to evaluate the prognostic significance of lymphopenia associated with chemotherapy in patients with colorectal cancer who received adjuvant chemotherapy after undergoing potentially curative surgery. Summary of background data: Lymphocyte plays an important role in anti-tumor immunity. Lymphopenia is sometimes induced during the period of adjuvant chemotherapy after potentially curative surgery for colorectal cancer. However, the prognostic significance of lymphopenia associated with chemotherapy is unknown. Methods: One hundred and fifteen patients who received adjuvant chemotherapy after potentially curative surgery for stage II/III colorectal cancer were enrolled in this study. All patients were classified into two groups, the lymphopenia group and the normal group, according to minimum lymphocyte count during the period of adjuvant chemotherapy. Lymphopenia was defined as a lymphocyte count of less than 1,000/Ã&#x8e;¼l. Lymphopenia associated with chemotherapy was found in 17 of the 115 patients (14.8%). Results: Lymphopenia was associated with a worse disease-free survival (p=0.018). Moreover, in a multivariate analysis, lymphopenia associated with chemotherapy was identified to be an independent prognostic factor.

Impact of preoperative chemotherapy on overall survival for borderline resectable colorectal liver metastases

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 365-365
Author(s):  
Akio Saiura ◽  
Yosuke Inoue ◽  
Yoshihiro Mise ◽  
Yu Takahashi ◽  
Takafumi Ichida ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Controlled Study ◽  
Free Survival ◽  
Surgical Failure ◽  
The Impact

365 Background: Treatment for borderline colorectal liver metastases (CLM) is often started with chemotherapy. However, the impact on overall survival (OS) is still unknown. Aims: The aim of this study is to analyze the impact of preoperative chemotherapy on the outcome for up-front resectable borderline CLMs (BLR-CLM). Methods: A retrospective review was performed of 169 patients who underwent liver resection of BLR-CLM among 510 patients underwent liver resection for CLM between 2005 and 2013. BLR-CRLM was defined as CRLM of four or more nodules or 5cm or larger nodule. Time to surgical failure (TSF) was defined as the time until unresectable relapse or death. OS, recurrence free survival (RFS) and TSF were compared between BLR-CLM treated with neoadjuvant chemotherapy (NAC) and up-front surgery (US). Results: After median follow-up period of 38 months, 5-year survival rate after liver resection of resectable cases (n = 263), BLR-CLM (n = 169), and initially unresectable CLM (n = 78) are 67.7%, 47.5% and 32.6%, respectively. For patients with BLR-CLM, 22 patients with early recurrence during or early after postoperative chemotherapy for the primary were excluded. In the remaining 147 patients, 75 patients were treated with NAC and 72 with US. Cumulative 5-year overall survival rates, progression free survival rates, and time-to surgical failure in NAC and US group are as follows: OS (60.1% vs 47.7%, p = 0.084), PFS (23.1% vs 15.5%, p < 0.0001), TSF (38.0% vs 34.4%, p = 0.020). Conclusions: Preoperative chemotherapy for BLR-CLM could improve PFS and TSF. The impact on OS was still marginal. Prospective controlled study will be necessary.

scholarly journals Prognostic Factors Affecting Survival of Patients after Liver Resection Due to Colorectal Liver Metastases

2016 ◽  
Vol 70 (3) ◽  
pp. 133-139
Author(s):  
Stefan Petrovski ◽  
Elena Arabadzhieva ◽  
Saso Bonev ◽  
Dimitar Bulanov ◽  
Valentin Popov ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Prognostic Significance ◽  
Radical Resection ◽  
University Hospital ◽  
Tumor Type ◽  
Term Survival ◽  
Localization Of Metastases

Abstract Introduction. Colorectal liver metastases have a poor prognosis and only 2% have an average 5-year survival if left untreated. In recent decades there has been a development in the diagnosis, treatment and palliative treatment of patients with colorectal liver metastases, and despite radical resection the average five-year survival is between 25% and 44%. Aim. To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the prognostic factors that affect survival after radical surgical treatment of patients. Methods. A retrospective study was conducted at the Clinic of General and Hepato-pancreatic Surgery at the University Hospital “Aleksandrovska”-Sofia. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. Clinical and pathological materials were analyzed using SPSS-19 to determine the prognostic significance of a number of factors in relation to the survival: gender, age, type and localization of metastases, postoperative stage of the primary tumor, type and volume of liver resection, extrahepatic metastases, preoperative values of CEA, postoperative values (AST, ALT). Results. Factors that correlated with lower survival type: metastases (synchronous or metachronus), localization of metastases (uni-or bilobar), presence of the regional lymph node metastases and metastases to other distant organs and the impossibility of radical resection of liver were statistically significant with multivariant analysis. Elevated preoperative value of CEA, the value of hemoglobin and stage IV disease also affected the survival of patients. Conclusion. In patients with colorectal liver metastases only resection has potentially curative character. The surgical strategy for resection in context of increasing the percentage of patients with resectable potential is the only possible factor for long-term survival.

scholarly journals Comparison of Sequential, Delayed and Simultaneous Resection Strategies for Synchronous Colorectal Liver Metastases

2020 ◽  
Author(s):  
Li-Jun Wang ◽  
Hong-Wei Wang ◽  
Ke-Min Jin ◽  
Juan Li ◽  
Bao-Cai Xing
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Primary Tumour ◽  
Term Survival ◽  
Surgical Strategies ◽  
Free Survival ◽  
Simultaneous Resection ◽  
Peking University ◽  
Synchronous Colorectal Liver Metastases

Abstract Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P =0.166). The overall survival at 1 and 3 years in the SeR group (93.9% and 50.1%) was lower than that in the DeR group (94.9% and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0% and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4% and 18.4%) was lower than that in the DeR group (43.9% and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4% and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases >30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

scholarly journals Comparison of Sequential, Delayed and Simultaneous Resection Strategies for Synchronous Colorectal Liver Metastases

2020 ◽  
Author(s):  
Li-Jun Wang ◽  
Hong-Wei Wang ◽  
Ke-Min Jin ◽  
Juan Li ◽  
Bao-Cai Xing
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Primary Tumour ◽  
Term Survival ◽  
Surgical Strategies ◽  
Free Survival ◽  
Simultaneous Resection ◽  
Peking University ◽  
Synchronous Colorectal Liver Metastases

Abstract Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P =0.166). The overall survival at 1 and 3 years in the SeR group (93.9% and 50.1%) was lower than that in the DeR group (94.9% and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0% and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4% and 18.4%) was lower than that in the DeR group (43.9% and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4% and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases >30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

scholarly journals Compare of Sequential, Delayed and Simultaneous Resection Strategies for Synchronous Colorectal Liver Metastases

2019 ◽  
Author(s):  
Li-Jun Wang ◽  
Hong-Wei Wang ◽  
Ke-Min Jin ◽  
Juan Li ◽  
Bao-Cai Xing
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Term Survival ◽  
Surgical Strategies ◽  
Free Survival ◽  
Simultaneous Resection ◽  
Peking University ◽  
Synchronous Colorectal Liver Metastases ◽  
Perioperative Safety

Abstract Background: The present study aimed to compare perioperative safety and long-term survival of patients with synchronous colorectal liver metastases receiving sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data of patients receiving surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, p=0.007) and the SeR group (16.3%, p=0.166). Overall survival at 1-year and 3-year in the SeR group (93.9% and 50.1%) was lower than the DeR group (94.9% and 64.8%, p=0.019), but not statistically different compared with the SiR group (93.0% and 55.2%, p=0.378). Recurrence-free survival at 1-year and 3-year in the SeR group (22.4% and 18.4%) was lower than the DeR group (43.9% and 24.2%, p=0.033), but not statistically different compared with the SiR group (31.4% and 19.6%, p=0.275). Cox multivariate analysis indicated that T4, lymph node positive primary tumor, liver metastases>30mm and selective sequential resection (compared with delayed resection) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complication, and when staged resection strategy was made, the prognosis of delayed resection was better than that of sequential resection.

scholarly journals Postoperative CEA is a better prognostic marker than CA19-9, hCGβ or TATI after resection of colorectal liver metastases

Tumor Biology ◽  
2018 ◽  
Vol 40 (1) ◽  
pp. 101042831775294 ◽  
Author(s):  
Reetta Peltonen ◽  
Pia Österlund ◽  
Marko Lempinen ◽  
Arno Nordin ◽  
Ulf-Håkan Stenman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Prognostic Marker ◽  
Colorectal Liver Metastases ◽  
Prognostic Significance ◽  
University Hospital ◽  
Colorectal Cancer Patients

Liver metastases of colorectal cancer can be operated with a curative intent in selected cases. However, more than half of the patients have a recurrence. The aim of this study was to evaluate the prognostic and predictive value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), human chorionic gonadotropin β (hCGβ) and tumour-associated trypsin-inhibitor (TATI) in colorectal cancer patients before and 3 months after resection of liver metastases. Marker concentrations were determined in blood samples from 168 colorectal cancer patients, who underwent liver resection between the years 1998 and 2007 at Helsinki University Hospital, Finland. The samples were taken before and 3 months after curative resection. Increased concentrations of CEA (>5 µg/L) and hCGβ (>1 pmol/L) 3 months after liver resection correlated with recurrence and impaired overall survival and increased CA19-9 (>26 kU/L) with impaired overall survival, but postoperative TATI was not prognostic. Preoperatively elevated CEA and CA19-9 correlated with impaired overall survival, but not with recurrence. Neither preoperative hCGβ nor TATI was prognostic. In conclusion, CEA is a useful prognostic marker, when measured 3 months after resection of colorectal liver metastases. CA19-9 also has prognostic significance and may have additional value.

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