Response to preoperative chemotherapy: impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases.

Autor:	Ruzzenente A; Department of Surgery, University of Verona, Verona, Italy., Bagante F; Department of Surgery, University of Verona, Verona, Italy; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Ratti F; Department of Surgery, Ospedale San Raffaele, Milano, Italy., Beal EW; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Alexandrescu S; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania., Merath K; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Makris EA; Department of Surgery, Stanford University, Stanford, CA, USA., Poultsides GA; Department of Surgery, Stanford University, Stanford, CA, USA., Margonis GA; Department of Surgery, The Johns Hopkins University Hospital, Baltimore, MD, USA., Weiss MJ; Department of Surgery, The Johns Hopkins University Hospital, Baltimore, MD, USA., Popescu I; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania., Aldrighetti L; Department of Surgery, Ospedale San Raffaele, Milano, Italy., Guglielmi A; Department of Surgery, University of Verona, Verona, Italy., Pawlik TM; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: tim.pawlik@osumc.edu.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2019 Sep; Vol. 21 (9), pp. 1230-1239. Date of Electronic Publication: 2019 Feb 19.
DOI:	10.1016/j.hpb.2019.01.014
Abstrakt:	Background: Progression of colorectal liver metastasis (CRLM) on preoperative chemotherapy has been associated with a worse prognosis compared with patients who have responsive disease. Defining response can be challenging as traditional criteria largely assess only tumor size. Methods: Patients who underwent hepatectomy between 2010 and 2017 were identified using a multi-centric database. This study aimed to define the impact of preoperative chemotherapy response relative to initial tumor burden score (TBS) and determine impact of clinico-pathological variables on overall survival (OS). Results: Among 784 patients who received preoperative chemotherapy, the regimen was oxaliplatin- (66%) or irinotecan-based (34%). Among patients with a TBS<6 at diagnosis, genetic status was the most important prognostic variable. Patients with a TBS<6, 5-year OS was 55%, 35%, and 0% for patients with KRAS/NRAS/BRAF wild-type, KRAS/NRAS, and BRAF mutations, respectively. Among patients who presented with CRLM with a TBS≥6, only Δ-TBS was prognostically important and patients with a Δ-TBS ≥ -10% had a 5-year OS of 27% compared with 49% for patients with a Δ-TBS < -10%. Conclusions: Prognostic stratification of patients with CRLM receiving preoperative chemotherapy should be multi-faceted and include consideration of initial tumor burden, change in tumor burden due to chemotherapy, and tumor genetic status. (Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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