Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases
| Autor: | Johann Pratschke, Roberta Bova, Daniel Seehofer, Peter Neuhaus, Maximilian Schmeding, Christoph Röcken, Hanno Riess, Marcus Bahra, Armin Thelen, Ulf Neumann, Sven Jonas |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Multivariate analysis Organoplatinum Compounds Colorectal cancer medicine.medical_treatment Leucovorin Kaplan-Meier Estimate Gastroenterology Carcinoembryonic antigen Risk Factors Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans In patient Longitudinal Studies Aged Retrospective Studies Chemotherapy biology business.industry Liver Neoplasms Cancer Middle Aged medicine.disease Combined Modality Therapy Carcinoembryonic Antigen Treatment Outcome Tumor progression Multivariate Analysis Disease Progression biology.protein Female Surgery Fluorouracil Hepatectomy Colorectal Neoplasms business Follow-Up Studies |
| Zdroj: | Surgery. 146:52-59 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2009.02.004 |
| Popis: | Background Liver resection is the only curative treatment offering a chance of long-term survival in patients with colorectal liver metastases (CRM). Recent data indicated that liver resection in patients with tumor progression while receiving chemotherapy was associated with poor outcome. The aim of the study was to identify risk factors for poor outcome in patients with pre-operative chemotherapy of CRM. Methods We analyzed 160 patients after liver resection for CRM with preoperative systemic. chemotherapy. Three groups of patients were identified: 44 patients (27.5%) had a tumor response, 20 (12.5%) showed stable disease, and 96 (60%) patients had tumor progression while on chemotherapy. Median follow-up was 2.4 years (range, 6 days–11.1 years). All available clinicopathologic variables possibly associated with outcome were evaluated. Results Survival was 88%, 53%, and 37% at 1, 3, and 5 years. Noncurative resection, carcinoembryonic antigen levels >200 ng/ml, tumor grading, size of the largest tumor >5 cm, and number of metastases were associated with poor patient outcome. In the multivariate analysis, tumor free margin and tumor grading correlated with the outcome. Tumor progression while on chemotherapy had no influence on the long-term survival. Conclusion Liver resection offers a long-term survival benefit for patients with CRM, even when tumor growth proceeds during pre-operative chemotherapy. |
| Databáze: | OpenAIRE |
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