Resection of colorectal liver metastases after early failure of adjuvant systemic chemotherapy for the primary tumor: Is there a role for additional treatment

Abstract

Introduction: The utility of adjuvant systemic chemotherapy after resection of colorectal liver metastasis (CRLM), especially after recent exposure to adjuvant treatment for the primary tumor, is controversial. This study compared adjuvant therapy with hepatic artery infusion (HAI) and systemic chemotherapy (HAI+Sys) and Sys alone to no treatment after resection of CRLM after recent failure of adjuvant chemotherapy for the primary tumor. Methods: Early CRLM was defined as the occurrence of CRLM within 12 months of finishing adjuvant chemotherapy for their primary tumor. 240 patients who underwent a complete resection of early CRLM for stage III CRC between 1992 and 2014 were included from a single-center prospectively maintained database. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier methods. A Cox proportional hazards model was used to evaluate the independent association between treatment groups after liver resection and outcomes. Results: 79 pts (32.9%) received adjuvant HAI+Sys, 77 (32.1%) adjuvant Sys alone and 84 (35%) no adjuvant therapy. Pts received HAI+Sys had a prolonged median RFS (HAI+Sys:1.8yr vs. Sys alone:1.2yr vs. Surveillance:1.4yr,p=0.02) and OS (HAI+Sys:6.2yr vs. Sys alone:4.0yr vs. Surveillance:4.1yr,p< 0.01). In multivariable model, the risk of death or a recurrence was nearly halved for pts treated with adjuvant HAI+Sys compared to pts with no adjuvant therapy (HR:0.6 [95%CI:0.43-0.93],p=0.02]. Other independent factors associated with improved OS were largest tumor size < 5cm (p=< 0.01) and left-sided colon tumors (p=< 0.01). Conclusion: Combined HAI and systemic chemotherapy is effective as adjuvant therapy after resection of early metachronous CRLM.