P-0221 - The outcome of preoperative chemotherapy followed by surgery or upfront surgery for resectable liver metastases from colorectal cancer: a single cen...

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Colon Cancer
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Il Choi Sang
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors I. Choi Sang1, C. Park Sung1, Y. Kim Dae2, H. Oh Jae1, D. Lee Seung1, S. Han1, H. Kim Seoung1, J. Park Sang1, Y. Kim Sun1, Y. Baek Ji1, K. Shim Eun1, M. Kim Hyun1, Y. Ku Ji3, I. Jang Mi Song1
  • 1National Cancer Center, Goyang/KR
  • 2Center for Colorectal Cancer, National Cancer Center, Goyang-si/KR
  • 3National Cancer Center, Ilsandong-gu/KR

Abstract

Introduction

Hepatic metastasectomy is the only curative option for patients (pts) with colorectal liver metastases (CRLM) but the optimal sequence of surgery and chemotherapy has not been established. We evaluated progression-free survival (PFS) in pts who were treated with different sequences for resectable CRLM.

Methods

Pts who had radiologically diagnosed with CRLM and underwent preoperative chemotherapy (preopCT) followed by surgery or upfront hepatic resection from Jan 2008 to Apr 2012, in National Cancer Center, Korea were identified and their medical records were reviewed. Pts with number of metastatic nodules (mets) less than 6 and histologically confirmed metastatic adenocarcinoma in liver were analyzed. Those with tumor invasion of major intrahepatic vessels, extrahepatic metastases, prior chemotherapy for metastatic disease, or combined other advanced cancer were excluded. Pts who were followed-up for more than 6 months were analyzed.

Results

Of consecutive 308 pts who underwent hepatic surgery for suspicious CRLM, 162 pts who fulfilled the above criteria were analyzed. 50 (31%) pts received preopCT followed by surgery and 112 (69%) pts underwent upfront surgery. Preop CT was given as fluoropyrimidine monotherapy (2%), oxaliplatin or irinotecan-based doublet (68%), doublet plus targeted agent such as bevacizumab or cetuximab (28%), or triplet with oxaliplatin, irinotecan plus fluoropyrimidine (2%). Objective response rate of preopCT was 52% (partial response in 26 out of 50). Postoperative chemotherapy was administered for 45 (90%) of preopCT group and 90 (80%) of upfront surgery group. Baseline characteristics including number of mets and baseline tumor marker levels were balanced between the two groups, except that R0 resection rate was higher in preopCT group compared to upfront surgery group (98% vs 89%, p = 0.05) and pts in preopCT group were slightly younger than upfront surgery group (mean age 57 vs 61, p = 0.06). PFS at 3-year was 22% (95% CI 12%-35%) in preopCT group and 47% (95% CI 37%-56%) in upfront surgery group (log rank p = 0.07). In multivariate analysis, the number of mets was the most significant factor predicting PFS (hazard ratio for PFS event = 1.33, p = 0.007) and preopCT was marginally associated with poor PFS (hazard ratio for PFS event = 1.5, p = 0.061). OS at 3-year was not significantly different between preopCT group and upfront surgery group (94% vs 82%, log rank p= 0.44).

Conclusion

Upfront surgery, rather than preopCT followed by surgery, might be a favorable treatment option for resectable CRLM in terms of PFS.