Pathologic response to preoperative chemotherapy in colorectal liver metastases: Fibrosis, not necrosis, predicts outcome Journal Article


Authors: Poultsides, G. A.; Bao, F.; Servais, E. L.; Hernandez Boussard, T.; DeMatteo, R. P.; Allen, P. J.; Fong, Y.; Kemeny, N. E.; Saltz, L. B.; Klimstra, D. S.; Jarnagin, W. R.; Shia, J.; D'Angelica, M. I.
Article Title: Pathologic response to preoperative chemotherapy in colorectal liver metastases: Fibrosis, not necrosis, predicts outcome
Abstract: Background: Pathologic response to preoperative chemotherapy for colorectal liver metastases (CLM) is associated with survival after hepatectomy. Histologically, dominant response patterns include fibrosis, necrosis and/ or acellular mucin, but some of these changes can appear without previous chemotherapy and their individual correlation with outcome is unknown. Methods: Pathology slides from patients who underwent CLM resection (irrespective of preoperative chemotherapy status) were rereviewed by a blinded pathologist. Pathologic response was recorded as the summation of percentage necrosis, fibrosis and acellular mucin. Associations between pathologic response, its components, preoperative chemotherapy, and survival were analyzed. Results: Pathology slides were rereviewed in 366 patients undergoing CLM resection from 2003 to 2007. Preoperative chemotherapy was administered in 249 (68 %) patients, who, when compared to no preoperative chemotherapy patients, had higher rates of overall pathologic response (57 vs. 46 %, P <.01), fibrosis (21 vs. 12 %, P <.01) and acellular mucin (6 vs. 3 %, P =.05) but similar rates of necrosis (30 vs. 31 %, P =.30). In patients receiving preoperative chemotherapy, overall pathologic response ≥75 % (5 year, 83 vs. 47 %, P<.01) and fibrosis ≥40 % (5 year, 87 vs. 51 %, P<.01) independently correlated with disease-specific survival after hepatectomy. Preoperative hepatic artery infusion chemotherapy (P =.04) and bevacizumab (P =.05) were marginally associated with overall pathologic response and fibrosis, respectively. Conclusions: Fibrosis is the predominant chemotherapyrelated pathologic alteration driving the association of treatment response with survival after CLM resection. Necrosis in CLM is not related to chemotherapy or outcome. © Society of Surgical Oncology 2012.
Journal Title: Annals of Surgical Oncology
Volume: 19
Issue: 9
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2012-09-01
Start Page: 2797
End Page: 2804
Language: English
DOI: 10.1245/s10434-012-2335-1
PROVIDER: scopus
PUBMED: 22476753
DOI/URL:
Notes: --- - "Export Date: 2 November 2012" - "CODEN: ASONF" - "Source: Scopus"
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MSK Authors
  1. Leonard B Saltz
    791 Saltz
  2. Ronald P DeMatteo
    637 DeMatteo
  3. Fei Bao
    7 Bao
  4. David S Klimstra
    978 Klimstra
  5. Jinru Shia
    720 Shia
  6. Peter Allen
    501 Allen
  7. Elliot Louis Servais
    17 Servais
  8. William R Jarnagin
    905 Jarnagin
  9. Yuman Fong
    775 Fong
  10. Nancy Kemeny
    544 Kemeny