Clinical outcomes of neoadjuvant chemotherapy for resectable colorectal liver metastasis with intermediate risk of postoperative recurrence: A multi‐institutional retrospective study

Abstract

Aims Risk‐scoring systems for colorectal liver metastasis (CRLM) after hepatectomy allow prognoses to be predicted preoperatively. We investigated the clinical outcomes of neoadjuvant chemotherapy for resectable CRLM according to patient risk status, aiming to determine the subgroup of patients who could benefit from neoadjuvant chemotherapy. Methods In this multi‐institutional retrospective analysis, the preoperative risk score was calculated from six previously reported factors: synchronous metastases, primary lymph node positivity, tumor number, largest tumor diameter, extrahepatic metastasis, and the preoperative carbohydrate antigen 19–9 level. Patients were divided into three groups according to their risk scores: low risk (score = 0), intermediate risk (score 1–10), and high risk (score ≥11). Overall and recurrence‐free survival curves were calculated using the Kaplan–Meier method. After propensity‐score matching in the intermediate‐risk group, we compared clinicopathological features and outcomes. Results There were 318 cases, from 20 institutions. The preoperative risk score could be calculated in 277 cases. There were 34, 192, and 51 patients in the low‐, intermediate‐, and high‐risk groups, respectively. Intermediate‐risk group patients who received neoadjuvant chemotherapy had significantly better recurrence‐free survival than that of patients without neoadjuvant chemotherapy ( P = .0453). After propensity‐score matching in the intermediate‐risk group, the recurrence‐free survival rate was better in patients who received neoadjuvant chemotherapy ( P = .0261). But the overall survival rate was not improved after the matching. Conclusion Neoadjuvant chemotherapy for resectable CRLM might prolong the recurrence‐free survival period for intermediate‐risk patients with preoperative risk scores in the range of 1–10, but the overall survival was not improved by neoadjuvant chemotherapy.

Geriatric prognostic scoring system predicts survival after hepatectomy for elderly patients with liver cancer

“…As a result, surgeons have more of a chance to perform hepatectomy for elderly patients. 12,21,22 However, elderly patients are often considered to be at higher risk for postoperative complications of major surgery, such as hepatectomy, and satisfactory surgical outcomes could not be expected for some patients. However, no definitive criteria are known to determine whether surgeons should perform hepatectomy in elderly patients.…”

“…Recently, the number of elderly patients with liver cancer has been increasing. As a result, surgeons have more of a chance to perform hepatectomy for elderly patients 12,21,22 . However, elderly patients are often considered to be at higher risk for postoperative complications of major surgery, such as hepatectomy, and satisfactory surgical outcomes could not be expected for some patients.…”

Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis

“…Conversely, those with borderline resectability might find neoadjuvant chemotherapy more suitable[ 28 , 47 , 48 ]. Notably, for patients who have not undergone chemotherapy or have been chemotherapy-free for the past 12 months, the clinical benefits of neoadjuvant chemotherapy may be more significant[ 49 , 50 ].…”

Effects of chronic liver disease on the outcomes of simultaneous resection of colorectal cancer with synchronous liver metastases: a propensity score matching study

“…The liver is the most common metastatic target of colorectal cancer, with liver metastasis found in approximately 15% of cases at diagnosis (5). Surgical resection, local ablation therapy, and adjuvant and neoadjuvant therapy are important treatment methods for patients with colorectal liver metastases (6)(7)(8)(9)(10). With advances in surgical, adjuvant, and neoadjuvant therapy, more patients with colorectal cancer and liver metastases can undergo radical excision.…”