Preoperative Hepatic and Regional Arterial Chemotherapy in Patients Who Underwent Curative Colorectal Cancer Resection

Abstract

Objective: To evaluate the effects of the addition of preoperative hepatic and regional arterial chemotherapy (PHRAC) on prognosis of stage II and III colorectal cancer (CRC) in a multicenter setting. Summary of Background Data: Our previous single-center pilot trial suggested that PHRAC in combination with surgical resection could reduce the occurrence of liver metastasis (LM) and improve survival in CRC patients. Methods: A prospective multi-center randomized controlled trial was conducted from December 2008 to December 2012 at 5 hospitals in China. Eligible patients with clinical stage II or III CRC who underwent curative resection were randomized to receive PHRAC plus adjuvant therapy (PHRAC arm) or adjuvant therapy alone (control arm). The primary endpoint was DFS. Secondary endpoints were cumulative LM rates, overall survival (OS), and safety (NCT00643877). Results: A total of 688 patients from 5 centers in China were randomly assigned (1:1) to each arm. The five-year DFS rate was 77% in the PHRAC arm and 65% in the control arm (HR ¼ 0.61, 95% CI 0.46-0.81; P ¼ 0.001). The 5-year LM rates were 7% and 16% in the PHRAC and control arms, respectively (HR ¼ 0.37, 95% CI 0.22-0.63; P < 0.001). The 5-year OS rate was 84% in the PHRAC arm and 76% in the control arm (HR ¼ 0.61, 95% CI 0.43-0.86; P ¼ 0.005). There were no significant differences regarding treatment related morbidity or mortality between the two arms. Conclusions: The addition of PHRAC could improve DFS in patients with stage II and III CRC. It reduced the incidence of LM and improved OS without compromising patient safety. Trial Registration: ClinicalTrials.gov identifier: NCT00643877.

Efficacy of various adjuvant chemotherapy methods in preventing liver metastasis from potentially curative colorectal cancer: A systematic review network meta‐analysis of randomized clinical trials

“… 20 However, the efficacy of intraoperative or postoperative PVIC in preventing postoperative LM in patients with CRC is controversial; therefore, it is currently rarely performed. 11 The results of our meta‐analysis suggested that PVIC had no obvious advantages in preventing LM and failed to show satisfactory results in postoperative OS and DFS and even increased the risk of hepatic toxicity. However, PVIC improved the rates of patient mortality and CRC recurrence during the follow‐up period.…”

“…Only 19 studies met the eligibility criteria and were included in the final analysis. 8 , 11 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 Gray literature was also searched; however, none met the inclusion criteria.…”

“… 38 Therefore, preventing LM or extending the time to LM is a clinical research hotspot in resectable CRC. 11 PVIC, HAIC and SC are common clinical treatments for LM prevention. 39 However, the clinical efficacy and side effects of these methods remain controversial.…”

“…However, study results have been inconsistent. 11 Most studies have only compared the efficacy between two treatment methods or between a certain treatment method and operation alone. No systematic comparison of these four methods (including operation alone) has been performed.…”

Construction of a DDR-related signature for predicting of prognosis in metastatic colorectal carcinoma

“…Metastatic Colorectal cancer (mCRC) is the third leading cause of cancer death globally, and the incidence of CRC, particularly mCRC, is increasing among younger people ( 2 , 3 ). Patients with localized CRC have a 5-year survival rate of 85% to 90%, while the mCRC patients were just about 12-14% ( 4 , 5 ). Finding reliable prognostic indicators to select high-DDRscore mCRC patients is critical for improving survival rates.…”