Abstract
BackgroundDespite introduction of effective chemotherapy protocols, it has remained uncertain, if patients with colorectal cancer (CRC) liver metastases should receive adjuvant therapy. Clinical or molecular predictors may help to select patients at high risk for disease recurrence and death who obtain a survival advantage by adjuvant chemotherapy.MethodsA total of 297 patients with potentially curative resection of CRC liver metastases were analyzed. These patients had no neoadjuvant therapy, no extrahepatic disease and negative resection margins. The primary endpoint was overall survival. Patients’ risk status was evaluated using the Memorial Sloan-Kettering Cancer Center clinical risk score (MSKCC-CRS). Multivariable analyses were performed using Cox proportional hazard models.ResultsA total of 137 (43%) patients had a MSKCC-CRS > 2. Adjuvant chemotherapy was administered to 116 (37%) patients. Patients who received adjuvant chemotherapy were of younger age (p = 0.03) with no significant difference in the presence of multiple metastases (p = 0.72) or bilobar metastases (p = 0.08). On multivariate analysis adjuvant chemotherapy was associated with improved survival in the entire cohort (Hazard ratio 0.69; 95% confidence interval 0.69–0.98). It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23–0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57–1.43).ConclusionsThe MSKCC-CRS offers a tool to select patients for adjuvant therapy after resection of CRC liver metastases. Validation in independent patient cohorts is required.
Highlights
Despite introduction of effective chemotherapy protocols, it has remained uncertain, if patients with colorectal cancer (CRC) liver metastases should receive adjuvant therapy
The available clinical data clearly demonstrate the need for strategies to tailor adjuvant therapy to patients who are likely to obtain a marked therapy-induced benefit in long-term outcome after potentially curative resection of CRC liver metastases
CRC patients who underwent surgical resection for histologically proven liver metastases between October 2001 and June 2009 and received adjuvant chemotherapy or no adjuvant therapy after potentially curative resection were eligible for the analyses
Summary
Despite introduction of effective chemotherapy protocols, it has remained uncertain, if patients with colorectal cancer (CRC) liver metastases should receive adjuvant therapy. The EORTC Intergroup Trial 40983 showed a significant benefit in progression-free survival in eligible patients who received pre-and postoperative therapy with the FOLFOX-4 protocol compared to surgery alone [8]. The long-term results of the EORTC Intergroup Trial 40983 did not show a significant improvement in five-year overall survival in the perioperative chemotherapy group [9]. The available clinical data clearly demonstrate the need for strategies to tailor adjuvant therapy to patients who are likely to obtain a marked therapy-induced benefit in long-term outcome after potentially curative resection of CRC liver metastases
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