Long-Term Outcomes of Perioperative Versus Neoadjuvant Chemotherapy for Resectable Colorectal Liver Metastases: An International Multicentre Propensity-Score Matched Analysis with Stratification by Contemporary Risk-Scoring.

Autor: Di Martino M; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain. marcellodima@gmail.com., Primavesi F; Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.; Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria., Syn N; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Dorcaratto D; Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain., de la Hoz Rodríguez Á; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain., Dupré A; Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.; Department of Surgical Oncology, Centre Léon Bérard, Lyon, France., Piardi T; Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France.; HPB Unit, Department of Surgery, Simone Veil Hospital, Troyes, France., Rhaiem R; Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France., Blanco Fernández G; Department of HBP and Liver Transplantation Surgery, University Hospital of Badajoz. INUBE (Instituto Universitario de Investigación Biosanitaria de Extremadura). University of Extremadura, Badajoz, Spain., de Armas Conde N; Department of HBP and Liver Transplantation Surgery, University Hospital of Badajoz. INUBE (Instituto Universitario de Investigación Biosanitaria de Extremadura). University of Extremadura, Badajoz, Spain., Rodríguez Sanjuán JC; Hospital Universitario Marqués de Valdecilla, Santander, Spain., Fernández Santiago R; Hospital Universitario Marqués de Valdecilla, Santander, Spain., Fernández-Moreno MC; Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain., Ferret G; Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain., López Ben S; Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain., Suárez Muñoz MÁ; Hospital Universitario Virgen de la Victoria, Malaga, Spain., Perez-Alonso AJ; Unidad de Cirugia HBP y Trasplante Hepático, Hospital Universitario Virgen de las Nieves, Granada, Spain., Koh YX; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Jones R; Institute of Translational Medicine, University of Liverpool, Liverpool, UK., Martín-Pérez E; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2022 Oct; Vol. 29 (11), pp. 6829-6842. Date of Electronic Publication: 2022 Jul 18.
DOI: 10.1245/s10434-022-12027-9
Abstrakt: Background: There is still debate regarding the principal role and ideal timing of perioperative chemotherapy (CTx) for patients with upfront resectable colorectal liver metastases (CRLM). This study assesses long-term oncological outcomes in patients receiving neoadjuvant CTx only versus those receiving neoadjuvant combined with adjuvant therapy (perioperative CTx).
Methods: International multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010 and 2015. Characteristics and outcomes were compared before and after propensity score matching (PSM). Primary endpoints were long-term oncological outcomes, such as recurrence-free survival (RFS) and overall survival (OS). Furthermore, stratification by the tumour burden score (TBS) was applied.
Results: Of 967 patients undergoing hepatectomy, 252 were analysed, with a median follow-up of 45 months. The unmatched comparison revealed a bias towards patients with neoadjuvant CTx presenting with more high-risk patients (p = 0.045) and experiencing increased postoperative complications ≥Clavien-Dindo III (20.9% vs. 8%, p = 0.003). Multivariable analysis showed that perioperative CTx was associated with significantly improved RFS (hazard ratio [HR] 0.579, 95% confidence interval [CI] 0.420-0.800, p = 0.001) and OS (HR 0.579, 95% CI 0.403-0.834, p = 0.003). After PSM (n = 180 patients), the two groups were comparable regarding baseline characteristics. The perioperative CTx group presented with a significantly prolonged RFS (HR 0.53, 95% CI 0.37-0.76, p = 0.007) and OS (HR 0.58, 95% CI 0.38-0.87, p = 0.010) in both low and high TBS patients.
Conclusions: When patients after resection of CRLM are able to tolerate additional postoperative CTx, a perioperative strategy demonstrates increased RFS and OS in comparison with neoadjuvant CTx only in both low and high-risk situations.
(© 2022. Society of Surgical Oncology.)
Databáze: MEDLINE
Externí odkaz: