Discrepancy Between Recurrence-Free Survival and Overall Survival in Patients with Resectable Colorectal Liver Metastases: A Potential Surrogate Endpoint for Time to Surgical Failure

Oba, Masaru; Hasegawa, Kiyoshi; Matsuyama, Yutaka; Shindoh, Junichi; Mise, Yoshihiro; Aoki, Taku; Sakamoto, Yoshihiro; Sugawara, Yasuhiko; Makuuchi, Masatoshi; Kokudo, Norihiro

doi:10.1245/s10434-014-3504-1

Cited by 79 publications

(79 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In accordance with previous studies [11,19,20], the present study showed better prognosis for patients who could undergo repeat resections than those who did not [5,10,20,21]. Patients who undergo repeat resections reportedly have longer survival than those who did not un- 14 (17) 12 ( dergo repeat resections, mainly because patients with unresectable recurrence disease do not receive repeat resections.…”

Section: Discussionsupporting

confidence: 90%

“…With this regard, it should be emphasized that the present study included only the patients with resectable hepatic recurrence. Reportedly, RFI <1 year and multiple recurrent tumor are predictors of unfavorable long-term outcomes after repeat resections [5,[9][10][11]22]. Accordingly, when we decided the indication of repeat hepatectomy, RFI and number of tumor were taken into account.…”

Section: Discussionmentioning

confidence: 99%

“…However, recurrence following hepatectomy reportedly occurs in 46-75% of patients and mostly in the remnant liver [2][3][4]. Therefore, longer OS (in contrast to shorter recurrence-free survival) in most patients is achieved with repeat hepatectomies, with or without che-DOI: 10.1159/000488217 motherapy [5]. Repeat resections, especially for hepatic or pulmonary recurrence, have been advocated to achieve longer survival [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Recurrence-free interval (RFI) after initial hepatectomy has been shown to be a prognostic predictor [4,5,[9][10][11], and to influence the repeat resection rate [4,9,10]. In our multidisciplinary meeting to discuss management of patients with especially short RFIs after initial hepatectomy, several months of observation or chemotherapy to exclude patients with rapidly progressing disease were proposed.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility of “Watch-and-Wait” Management before Repeat Hepatectomy for Colorectal Liver Metastases

Kishi¹,

Nara²,

Esaki³

et al. 2018

Dig Surg

View full text Add to dashboard Cite

Background: Whether repeat hepatectomy for colorectal liver metastases should be performed after chemotherapy or observation is unclear. Methods: We selected patients with resectable hepatic recurrence after their first hepatectomies performed between 2000 and 2015. They were classified according to the further treatment: Group A, prompt repeat hepatectomy; Group B, observation; and Group C, ≤6 months of chemotherapy. In Group B/C, patients who later underwent hepatectomy and those who did not due to disease progression were classified as B1/C1 and B2/C2, respectively. Predictors of B2/C2 were evaluated. Results: Groups A, B, and C consisted of 81, 36, and 17 patients, respectively. Recurrence-free interval was longer in Group A (median months; Group A, 10.3; Group B, 5.7; Group C, 3.5; p < 0.01). Group B1/C1 and B2/C2 included 34 and 19 patients, respectively. Five-year survival after recurrence of Group B1/C1 was 56%, which was comparable with Group A (56%, p = 0.77) and better than Group B2/C2 (0%, p < 0.01). Multivariate analysis showed synchronous colorectal liver metastases (OR 7.23) and recurrent hepatic tumor number (OR 4.04) were predictors of tumor progression. Conclusion: Selecting patients optimally either for prompt or delayed repeat hepatectomy following chemotherapy or observation is a feasible strategy.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility of “Watch-and-Wait” Management before Repeat Hepatectomy for Colorectal Liver Metastases

Kishi¹,

Nara²,

Esaki³

et al. 2018

Dig Surg

View full text Add to dashboard Cite

show abstract

“…This is reflected in our series by the fact that more than 80% of patients had a node-positive primary, synchronous presentation and multiple bilateral disease all together. However, DFS rate is no more a reliable predictor for OS in patients with CRLM because the prolonged cumulative tumorfree interval that can be achieved through repeated resections or other multimodal therapies improves survival outcomes [23][24][25]. In our series, when recurrence oc- In classic TSH, up to 32% of patients do not survive up to the completion of the second stage due to progression of disease or insufficient FLR hypertrophy [26].…”

Section: Discussionmentioning

confidence: 65%

The ALPPS Approach for Colorectal Liver Metastases: Impact of KRAS Mutation Status in Survival

Serenari

Alvarez²,

Ardiles³

et al. 2017

Dig Surg

View full text Add to dashboard Cite

Background/Aims: Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations influence survival after hepatectomy for colorectal liver metastases (CRLM). However, their prognostic significance has never been evaluated in patients who undergo Associating Liver Partition and Portal vein occlusion for Staged hepatectomy (ALPPS). Methods: Between June 2011 and March 2016, 26 patients underwent ALPPS for CRLM. Complications were classified according to the Clavien-Dindo classification. Bi- and multivariate cox analyses were performed to evaluate variables potentially associated with survival. Results: Overall, morbidity grade ≥3a and 90-day mortality were 38.5 and 0%, respectively. The median follow-up from the time of discharge was 21.5 months (interquartile range 9.6-35.6). One- and 3-year overall survival (OS) was 83.4 and 48.9%, respectively. Patients with mutated (MT) KRAS had a median OS of 15.3 vs. 38.3 months for those with wild-type (WT) KRAS (p < 0.0001). Median disease-free survival was 7.9, 5.6 vs. 12.3 months for MT and WT KRAS, respectively (p = 0.023). KRAS mutation was found to be an independent risk factor for OS (hazard ratio 7.15, 95% CI 1.50-34.11; p = 0.014). Conclusion: KRAS mutation is an independent predictor of poor survival after ALPPS. This finding will help to optimize patient selection, both avoiding futile surgical indication and maximizing the benefit for patients with extensive disease who are otherwise subjected to high-risk aggressive surgery.

show abstract

Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer

et al. 2022

View full text Add to dashboard Cite

IMPORTANCEThe long-term safety of laparoscopic distal gastrectomy for locally advanced gastric cancer (AGC) remains uncertain given the lack of 5-year follow-up results.OBJECTIVE To compare the 5-year follow-up results in patients with clinically AGC enrolled in the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-02 randomized clinical trial who underwent laparoscopic or open distal gastrectomy. DESIGN, SETTING, AND PARTICIPANTSThe KLASS-02, a multicenter randomized clinical trial, showed that laparoscopic surgery was noninferior to open surgery for patients with locally AGC. The present study assessed the 5-year follow-up results, including 5-year overall survival (OS) and relapse-free survival (RFS) rates and long-term complications, in patients enrolled in KLASS-02. From November 21, 2011, to April 29, 2015 aged 20 to 80 years diagnosed preoperatively with locally AGC were enrolled. Final follow-up was on June 15, 2021. Data were analyzed June 24 to September 9, 2021. INTERVENTIONS Patients were treated with R0 resection either by laparoscopic gastrectomy or open gastrectomy as the full analysis set of the KLASS-02 trial. MAIN OUTCOMES AND MEASURES Five-year OS and RFS rates, recurrence patterns, and long-term surgical complications were evaluated. RESULTS This study enrolled a total of 1050 patients. A total of 974 patients were treated with R0 resection; 492 (50.5%) in the laparoscopic gastrectomy group (mean [SD] age, 59.8 [11.0] years; 351 men [71.3%]) and 482 (49.5%) in the open gastrectomy group (mean [SD] age, 59.4 [11.5] years; 335 men [69.5%]). In patients who underwent laparoscopic and open distal gastrectomy, the 5-year OS (88.9% vs 88.7%) and RFS (79.5% vs 81.1%) rates did not differ significantly. The most common types of recurrence were peritoneal carcinomatosis (73 of 173 [42.1%]), hematogenous metastases (36 of 173 [20.8%]), and locoregional recurrence (23 of 173 [13.2%]), with no between-group differences in types of recurrence at each cancer stage. The correlation between 3-year RFS and 5-year OS at the individual level was highest in patients with stage III gastric cancer (ρ = 0.720). The late complication rate was significantly lower in the laparoscopic than in the open surgery group (32 of 492 [6.5%] vs 53 of 482 [11.0%]). The most common type of complication in both groups was intestinal obstruction (13 of 492 [2.6%] vs 24 of 482 [5.0%]). CONCLUSIONS AND RELEVANCEThe 5-year outcomes of the KLASS-02 trial support the 3-year results, which is the noninferiority of laparoscopic surgery compared with open gastrectomy for locally AGC. The laparoscopic approach can be recommended in patients with locally AGC to achieve the benefit of low incidence of late complications.

show abstract

Discrepancy Between Recurrence-Free Survival and Overall Survival in Patients with Resectable Colorectal Liver Metastases: A Potential Surrogate Endpoint for Time to Surgical Failure

Abstract: The correlation between TSF and OS was stronger than that between RFS and OS after curative hepatic resection. TSF could be a suitable endpoint for CLM overall management.

Cited by 79 publications

References 22 publications

Feasibility of “Watch-and-Wait” Management before Repeat Hepatectomy for Colorectal Liver Metastases

Feasibility of “Watch-and-Wait” Management before Repeat Hepatectomy for Colorectal Liver Metastases

The ALPPS Approach for Colorectal Liver Metastases: Impact of KRAS Mutation Status in Survival

Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer

Contact Info

Product

Resources

About