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Resection of colorectal liver metastases after second-line chemotherapy : is it worthwhile? A LiverMetSurvey analysis of 6415 patients
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Adam, René, Yi, Bin, Innominato, Pasquale F., Barroso, Eduardo, Laurent, Christophe, Giuliante, Felice, Capussotti, Lorenzo, Lapointe, Réal, Regimbeau, Jean-Marc, Lopez-Ben, Santiago, Isoniemi, Helena, Hubert, Catherine, Lin, Jen-Kou, Gruenberger, Thomas, Elias, Dominique, Skipenko, Oleg G. and Guglielmi, Alfredo (2017) Resection of colorectal liver metastases after second-line chemotherapy : is it worthwhile? A LiverMetSurvey analysis of 6415 patients. European Journal of Cancer, 78 . pp. 7-15. doi:10.1016/j.ejca.2017.03.009
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Official URL: http://dx.doi.org/10.1016/j.ejca.2017.03.009
Abstract
Purpose
Patient outcome after resection of colorectal liver metastases (CLM) following second-line preoperative chemotherapy (PCT) performed for insufficient response or toxicity of the first-line, is little known and has here been compared to the outcome following first-line.
Patients and methods
From January 2005 to June 2013, 5624 and 791 consecutive patients of a prospective international cohort received 1 and 2 PCT lines before CLM resection (group 1 and 2, respectively). Survival and prognostic factors were analysed.
Results
After a mean follow-up of 30.1 months, there was no difference in survival from CLM diagnosis (median, 3-, and 5-year overall survival [OS]: 58.6 months, 76% and 49% in group 2 versus 58.9 months, 71% and 49% in group 1, respectively, P = 0.32). After hepatectomy, disease-free survival (DFS) was however shorter in group 2: 17.2 months, 27% and 15% versus 19.4 months, 32% and 23%, respectively (P = 0.001). Among the initially unresectable patients of group 1 and 2, no statistical difference in OS or DFS was observed. Independent predictors of worse OS in group 2 were positive primary lymph nodes, extrahepatic disease, tumour progression on second line, R2 resection and number of hepatectomies/year <50. Positive primary nodes, synchronous and bilateral metastases were predictors of shorter DFS. Initial unresectability did not impact OS or DFS in group 2.
Conclusion
CLM resection following second-line PCT, after oncosurgically favourable selection, could bring similar OS compared to what observed after first-line. For initially unresectable patients, OS or DFS is comparable between first- and second-line PCT. Surgery should not be denied after the failure of first-line chemotherapy.
| Item Type: | Journal Article | ||||||||
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| Divisions: | Faculty of Medicine > Warwick Medical School | ||||||||
| Journal or Publication Title: | European Journal of Cancer | ||||||||
| Publisher: | Pergamon | ||||||||
| ISSN: | 0959-8049 | ||||||||
| Official Date: | June 2017 | ||||||||
| Dates: |
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| Volume: | 78 | ||||||||
| Page Range: | pp. 7-15 | ||||||||
| DOI: | 10.1016/j.ejca.2017.03.009 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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