Response to neoadjuvant chemotherapy does not predict overall survival for patients with synchronous colorectal hepatic metastases Journal Article

Authors: Gallagher, D. J.; Zheng, J.; Capanu, M.; Haviland, D.; Paty, P.; DeMatteo, R. P.; D'Angelica, M.; Fong, Y.; Jarnagin, W. R.; Allen, P. J.; Kemeny, N.
Article Title: Response to neoadjuvant chemotherapy does not predict overall survival for patients with synchronous colorectal hepatic metastases
Abstract: Objective: We investigated the relation between response to neoadjuvant chemotherapy and overall survival (OS) in patients with colorectal liver metastases (CLM). Background: It has previously been reported that patients with synchronous CLM whose disease progresses while receiving neoadjuvant chemotherapy or who do not receive neoadjuvant chemotherapy experience worse survival than patients whose disease responds to neoadjuvant chemotherapy. Methods: By means of a prospectively maintained surgical database, between 1995 and 2003, we identified 111 patients with a synchronous CLM who received neoadjuvant chemotherapy before hepatic resection. The disease of all 111 patients was deemed resectable, and patients underwent hepatic resection with curative intent. Results: The median OS after liver resection was 62 months, with a median follow-up of 63 months. Median OS was similar between the three study groups classified by response to neoadjuvant chemotherapy (complete or partial response, 58 months; stable disease, 65 months; and disease progression, 61 months; P = .98). By univariate analysis, carcinoembryonic antigen level after liver resection of <5 ng/dL, size of metastatic lesion of ≤5 cm, lymph node-negative primary tumor, and disease-negative margins were associated with improved survival. Patients in the disease progression group had more positive margins and metastases >5 cm in size than patients in the complete or partial response group and the stable disease group. Patients whose tumor progressed but who received postoperative hepatic arterial infusion had a trend toward improved survival compared with those who did not receive hepatic arterial infusion (70% vs. 50% at 3 years, permutation log rank test P = .12). Conclusions: Response to neoadjuvant chemotherapy did not correlate with OS even after controlling for margins, stage of primary tumor, and postoperative carcinoembryonic antigen level. Postoperative salvage treatment may have helped the survival of some patients. © 2009 Society of Surgical Oncology.
Keywords: adult; cancer survival; controlled study; treatment response; aged; aged, 80 and over; middle aged; survival analysis; retrospective studies; major clinical study; overall survival; clinical trial; fluorouracil; cancer growth; antineoplastic agents; liver neoplasms; adjuvant therapy; cancer adjuvant therapy; postoperative care; chemotherapy, adjuvant; neoadjuvant therapy; outcome assessment; follow up; prospective study; colorectal cancer; controlled clinical trial; tumor volume; carcinoembryonic antigen; prediction; patient identification; irinotecan; colorectal neoplasms; liver metastasis; disease progression; folinic acid; liver resection; oxaliplatin; databases as topic
Journal Title: Annals of Surgical Oncology
Volume: 16
Issue: 7
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2009-01-01
Start Page: 1844
End Page: 1851
Language: English
DOI: 10.1245/s10434-009-0348-1
PUBMED: 19224284
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 7" - "Export Date: 30 November 2010" - "CODEN: ASONF" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Junting Zheng
    137 Zheng
  2. Philip B Paty
    385 Paty
  3. Ronald P DeMatteo
    614 DeMatteo
  4. Marinela Capanu
    228 Capanu
  5. Peter Allen
    460 Allen
  6. William R Jarnagin
    610 Jarnagin
  7. Yuman Fong
    750 Fong
  8. Nancy Kemeny
    387 Kemeny