Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis

Abstract

Patients with nonresectable colorectal cancer receiving palliative chemotherapy have a 5-year overall survival rate of about 10%. Liver transplant provided a Kaplan-Meier-estimated 5-year overall survival of up to 83%. The objective of the study was to evaluate the ability of different scoring systems to predict long-term overall survival after liver transplant. Patients with colorectal cancer with nonresectable liveronly metastases determined by computed tomography (CT)/magnetic resonance imaging/positron emission tomography (PET)-CT scans from 2 prospective studies (SECA-I and -II) were included. All included patients had previously received chemotherapy. PET-CT was performed within 90 days of the liver transplant. Overall survival, disease-free survival, and survival after relapse based on the Fong Clinical Risk Score, total PET liver uptake (metabolic tumor volume), and Oslo Score were compared. At median follow-up of 85 months for live patients, Kaplan-Meier overall survival rates at 5 years were 100%, 78%, and 67% in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume-low group, and Oslo Score 0 to 2, respectively. Median overall survival was 101, 68, and 65 months in patients with Fong ClinicalRisk Score 0 to 2, metabolic tumor volume-low, and Oslo Score 0 to 2. These selection criteria may be used to obtain 5-year overall survival rates comparable to other indications for liver transplant. K E Y W O R D Scancer/malignancy/neoplasia, cancer/malignancy/neoplasia: metastatic disease, clinical research/practice, clinical trial, liver disease: malignant, liver transplantation/hepatology

The Role of Liver Transplantation for Liver Metastasis from Colorectal Cancer

“…In this context, using the selected cohort from SECA-I and II, the Oslo group attempted to compare three selection criteria, Oslo score 0 to 2, Fong score 0 to 2, and PET-MTV (metabolic tumor value) value <70 cm. 3,21 Again although based on small cohort data, this analysis indicates the possibility of improved outcome with development of appropriate selection criteria. However, the stricter the criteria, the greater the potential to exclude patients who could benefit, a common pitfall in developing selection criteria.…”

Liver Transplantation for Colorectal Liver Metastasis

“…Within the Oslo Criteria, the CEA level and the response to chemotherapy are surrogates for the biological behavior of the disease. A Fong Clinical Risk Score of 0-2 has also been shown to be associated with superior long-term survival, and this score shares some factors with the Oslo Score [5,35]. Some other factors are distinctly associated with inferior survival: right-sided primary tumor location [35,36] and a metabolic tumor volume (MTV) exceeding 70 cm 3 on pre-transplant 18F-FDG PET/CT [37] are both strong predictors of inferior outcome.…”

“…A Fong Clinical Risk Score of 0-2 has also been shown to be associated with superior long-term survival, and this score shares some factors with the Oslo Score [5,35]. Some other factors are distinctly associated with inferior survival: right-sided primary tumor location [35,36] and a metabolic tumor volume (MTV) exceeding 70 cm 3 on pre-transplant 18F-FDG PET/CT [37] are both strong predictors of inferior outcome. Moreover, patients that, on quality of life assessment with European Organization for Research and Treatment of Cancer questionnaire version 3.0 (EORTC QLQ-C30) prior to transplant, display a high score, and in particularly those that have loss of appetite, have significantly worse survival [38••].…”

Frontiers in liver transplantation

“…Attempts at transplanting patients with secondary liver tumours have met with variable outcomes. During the past 10 years, accumulating evidence suggests that selected patients with extensive, otherwise unresectable, liver‐only metastases from neuroendocrine tumours and colorectal cancer can be offered OLT with very good survival outcomes comparable to those for conventional indications. A common feature of transplant criteria for both these secondary tumours is a clear demonstrable response to oncological treatment and disease stability over a prolonged observation time before listing for OLT.…”