Abstract

Background: Not all the patients with resectable colorectal liver metastases (CLM) benefit from liver resection (LR). Patients with disease progression during chemotherapy are excluded from surgery. To elucidate if the tumor behavior in the interval between the end of chemotherapy and LR (stable disease vs. progression) impacts prognosis. Methods: All the consecutive patients undergoing LR between 2006 and 2015 after tumor response or stabilization at chemotherapy were considered. The 128 patients with two imaging modalities after chemotherapy and an interval between the two >3 weeks were retained. Any variation of CLM size was registered. Progression was defined according to RECIST criteria. Results: 32 out of 128 (25%) patients had disease progression after chemotherapy, 17% if the interval chemotherapy-surgery was <8 weeks. The risk of progression was independent of the response to chemotherapy. Patients with progression after the end of chemotherapy had lower survival than patients with stable disease (3-year overall survival (OS) 23.0% vs. 52.4%; 3-year recurrence-free survival (RFS) 6.3% vs. 21.6%, p<0.001 for both). Survival was extremely poor in case of early progression (<8 weeks) (0% 2-year RFS and OS). Progression was an independent prognostic factor of OS and RFS (HR=2.949, p=0.001 and HR=2.350, p<0.001). Conclusion: Early disease progression between the end of chemotherapy and LR occurs in ∼15% of patients. It is associated with extremely poor survival and should be considered a contraindication to surgery.

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