Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy Journal Article

Authors: Auer, R. C.; White, R. R.; Kemeny, N.; Schwartz, L. H.; Shia, J.; Blumgart, L. H.; DeMatteo, R. P.; Fong, Y.; Jarnagin, W. R.; D'Angelica, M. I.
Article Title: Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy
Abstract: BACKGROUND: During chemotherapy, some colorectal liver metastases (LMs) disappear on serial imaging. This disappearance may represent a complete response (CR) or a reduction in the sensitivity of imaging during chemotherapy. The objective of the current study was to determine the fate of disappearing LMs (DLMs) and the factors that predict a true CR. METHODS: Between 2000 and 2003, 435 patients who were evaluated by hepatobiliary surgeons received chemotherapy before they were considered for resection. Inclusion criteria were <12 LMs before chemotherapy, at least 1 DLM on a computed tomography (CT) scan, and either surgical resection or 1 year of clinical follow-up after the disappearance of LMs. A true CR was defined as either a pathologic CR (no tumor detected in the resection specimen) or a durable clinical CR (did not reappear on follow-up imaging). Clinical and pathologic factors were analyzed to identify those associated with a true CR. RESULTS: During chemotherapy, 39 patients (9%) had a total of 118 DLMs on follow-up CT scans. Sixty-eight DLMs were resected, and 50 were followed clinically. Overall, 75 DLMs (64%) were true CRs, including 44 pathologic CRs and 31 durable clinical CRs. On multivariate analysis, the use of hepatic arterial infusion (HAI) chemotherapy (odds ratio [OR], 6.2; P = .02), the inability to observe the DLM on a magnetic resonance image (OR, 4.7; P = .005), and normalization of serum carcinoembryonic antigen levels (OR, 4.6; P = .006) were associated independently with a true CR. CONCLUSIONS: Approximately 66% of DLMs represented a true CR according to assessment by resection or radiologic follow-up. Predictive factors may help to stratify patients who are likely to harbor residual disease. © 2010 American Cancer Society.
Keywords: adult; cancer survival; human tissue; treatment outcome; treatment response; aged; middle aged; survival rate; major clinical study; overall survival; clinical trial; cancer recurrence; bevacizumab; fluorouracil; liver neoplasms; chemotherapy, adjuvant; combined modality therapy; follow up; prospective studies; colorectal cancer; antineoplastic combined chemotherapy protocols; carcinoembryonic antigen; recurrence; pathology; cetuximab; irinotecan; colorectal neoplasms; survival time; liver metastasis; folinic acid; remission induction; liver resection; radiography; drug therapy; oxaliplatin; radiofrequency ablation; floxuridine; predictive value; tomography, emission-computed; local recurrence; secondary liver neoplasms
Journal Title: Cancer
Volume: 116
Issue: 6
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2010-03-15
Start Page: 1502
End Page: 1509
Language: English
DOI: 10.1002/cncr.24912
PUBMED: 20120032
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 6" - "Export Date: 20 April 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Leslie H Blumgart
    340 Blumgart
  2. Ronald P DeMatteo
    597 DeMatteo
  3. Lawrence H Schwartz
    281 Schwartz
  4. Jinru Shia
    450 Shia
  5. William R Jarnagin
    583 Jarnagin
  6. Yuman Fong
    741 Fong
  7. Nancy Kemeny
    347 Kemeny