Evaluating the benefits of perioperative systemic chemotherapy plus targeted agents in patients undergoing liver resection for colorectal cancer metastases.

Abstract

e14073 Background: Liver metastases occur in up to 60% of patients with colorectal cancer (CRC). Hepatic resection provides the best chance for long-term survival; however, most published data is from the 5-FU era. This study examines prognostic factors and survival outcomes in the era of peri-operative targeted therapy for patients undergoing liver resection in the setting of CRC with liver metastases. Methods: 164 patients who underwent liver resection for CRC metastases from 2000–2008 were evaluated. Of these patients, 44 (26.8%) received perioperative chemotherapy, 12 (7.3%) received adjuvant chemotherapy, and 45 (27.4%) received neoadjuvant chemotherapy prior to surgery. The remaining patients did not receive chemotherapy. Kaplan-Meier estimation and log rank tests were used to identify potential prognostic factors of overall survival (OS) and disease-free survival (DFS). Results: The median age was 61 and the median follow-up time for all patients was 15.8 months. 95 (58%) patients had metachronous lesions. 28 (17.1%) received 5-FU/LV, 30 (18.3%) FOLFOX, 13 (8%) FOLFIRI, 43 (26.2%) systemic chemotherapy + bevacizumab, 5 (3%) systemic chemotherapy + cetuximab. 54 (33%) patients had >1 liver lesions and two patients had R1 resection. OS rates at 1, 3, and 5 years were 93.6%, 81.5%, and 39.0%, respectively. DFS rates were 82.4%, 42.3%, and 16.6%, respectively. Timing of chemotherapy did not influence overall outcome (OS p = 0.42, DFS p = 0.43). Systemic + targeted chemotherapy (i.e., bevacizumab or cetuximab) did not show an influence on DFS (p = 0.84) but was associated with improved OS (3-yr 83.4% vs 55.2%, p = 0.06) when compared to systemic chemotherapy alone. In univariate analysis primary tumor stage (p = 0.12) and multiple liver lesions (p = 0.07) were not statistically significant to be predictive of DFS or OS. Conclusions: There is a trend towards benefit of using systemic + targeted therapy with liver resection. Further prospective studies need to be done to confirm this finding. No significant financial relationships to disclose.