Patients with initially irresectable colorectal liver metastases: Is there a possibility of cure by an oncosurgical approach?
2008; Lippincott Williams & Wilkins; Volume: 26; Issue: 15_suppl Linguagem: Inglês
10.1200/jco.2008.26.15_suppl.4023
ISSN1527-7755
AutoresR. Adam, Dennis A. Wicherts, Rainer Haas, Oriana Ciacio, Françis Lévi, Bernard Paule, Michel Ducreux, Daniel Azoulay, D. Castaing,
Tópico(s)Cancer Genomics and Diagnostics
Resumo4023 Background: Although improved oncosurgical strategies for patients with irresectable colorectal liver metastases (CLM) have lead to increased survival, the potential of cure is still questionned. The objective was to evaluate long-term outcome after combining downsizing chemotherapy and rescue surgery to define prognostic factors of cure. Methods: All patients with initially irresectable CLM that underwent rescue surgery and had a minimum follow-up of 5 years were included. Irresectability was stated as the impossibility to resect all metastases while saving 30% of normal liver. Cure was defined as a disease-free interval >5 years from last hepatic or extrahepatic resection until last follow-up. Results: Mean age of 184 resected patients (April 1988-July 2002) was 56.9 years. Patients had a mean number of 5.3 liver metastases (bilobar in 76%), associated to extrahepatic disease in 27%. Surgery was possible after first (74%) or subsequent line (26%) of chemotherapy. Five- and 10-year overall survival were 33% and 27%. Of 148 patients with a follow-up >5 years, 24 (16%) were considered cured (mean follow-up 118.6 months), 6 of which (25%) after repeat resection of recurrence. Twelve “cured” patients (50%) had a disease-free interval >10 years. Cured patients more often presented with <3 metastases <30 mm (P=0.03), responding to first line chemotherapy (Table). Multivariate analysis identified maximum size of metastases <30 mm at diagnosis, number of metastases at liver resection 3 13(54%) 11(46%) 34(34%) 66 (66%) 0.07 Size (mm) <30 ≥30 7(30%) 16(70%) 12(12%) 85(88%) 0.03 Bilobar 16(67%) 89(80%) 0.18 Extrahepatic disease 4(17%) 36(32%) 0.13 No. of chemotherapy lines <2 ≥2 21(88%) 3(13%) 75(67%) 37(33%) 0.05 No. of chemotherapy cycles (mean+SD) 10.6+6.3 10.9+5.3 0.85 Complete pathological response 5(21%) 1(1%) <0.001 No significant financial relationships to disclose.
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