Luca Vigano1, Shadya Sara Darwish1, Lorenza Rimassa2, Matteo Cimino1, Carlo Carnaghi2, Matteo Donadon1, Fabio Procopio1, Nicola Personeni2, Daniele Del Fabbro1, Armando Santoro2, Guido Torzilli3. 1. Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Rozzano, Milan, Italy. 2. Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy. 3. Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Rozzano, Milan, Italy. guido.torzilli@hunimed.eu.
Abstract
BACKGROUND: Not all patients with resectable colorectal liver metastases (CLM) benefit from liver resection (LR); only patients with disease progression during chemotherapy are excluded from surgery. OBJECTIVE: This study was performed to determine whether tumor behavior (stable disease/progression) from the end of chemotherapy to LR impacts prognosis. METHODS: Patients undergoing LR after tumor response or stabilization during chemotherapy were considered. Overall, 128 patients who underwent examination by two imaging modalities (computed tomography/magnetic resonance imaging) after chemotherapy with a > 3-week interval between the two imaging modalities were analyzed. Any variation in CLM size was registered. Tumor progression was defined according to the response evaluation criteria in solid tumors (RECIST) criteria. RESULTS: Among 128 patients with stable disease or partial response to preoperative chemotherapy, 32 (25%) developed disease progression in the chemotherapy to LR interval, with a disease progression rate of 17% when this interval was < 8 weeks. Survival was lower among patients with progression than those with stable disease [3-year overall survival (OS) 23.0 vs. 52.4%, and recurrence-free survival (RFS) 6.3% vs. 21.6%; p < 0.001]. Survival was extremely poor in patients with early progression (< 8 weeks) (0.0% 2-year OS, 12.5% 6-month RFS). Disease progression in the chemotherapy to LR interval was an independent negative prognostic factor for OS and RFS [hazard ratio 3.144 and 2.350, respectively; p < 0.001]. CONCLUSIONS: Early disease progression in the chemotherapy to LR interval occurred in approximately 15% of patients and was associated with extremely poor survival. Even if these data require validation, the risk for early disease progression after chemotherapy should be considered, and, if progression is evident, the indication for surgery should be cautiously evaluated.
BACKGROUND: Not all patients with resectable colorectal liver metastases (CLM) benefit from liver resection (LR); only patients with disease progression during chemotherapy are excluded from surgery. OBJECTIVE: This study was performed to determine whether tumor behavior (stable disease/progression) from the end of chemotherapy to LR impacts prognosis. METHODS:Patients undergoing LR after tumor response or stabilization during chemotherapy were considered. Overall, 128 patients who underwent examination by two imaging modalities (computed tomography/magnetic resonance imaging) after chemotherapy with a > 3-week interval between the two imaging modalities were analyzed. Any variation in CLM size was registered. Tumor progression was defined according to the response evaluation criteria in solid tumors (RECIST) criteria. RESULTS: Among 128 patients with stable disease or partial response to preoperative chemotherapy, 32 (25%) developed disease progression in the chemotherapy to LR interval, with a disease progression rate of 17% when this interval was < 8 weeks. Survival was lower among patients with progression than those with stable disease [3-year overall survival (OS) 23.0 vs. 52.4%, and recurrence-free survival (RFS) 6.3% vs. 21.6%; p < 0.001]. Survival was extremely poor in patients with early progression (< 8 weeks) (0.0% 2-year OS, 12.5% 6-month RFS). Disease progression in the chemotherapy to LR interval was an independent negative prognostic factor for OS and RFS [hazard ratio 3.144 and 2.350, respectively; p < 0.001]. CONCLUSIONS: Early disease progression in the chemotherapy to LR interval occurred in approximately 15% of patients and was associated with extremely poor survival. Even if these data require validation, the risk for early disease progression after chemotherapy should be considered, and, if progression is evident, the indication for surgery should be cautiously evaluated.
Authors: L Viganò; B Branciforte; V Laurenti; G Costa; F Procopio; M Cimino; D Del Fabbro; L Di Tommaso; G Torzilli Journal: Ann Surg Oncol Date: 2022-06-10 Impact factor: 4.339
Authors: Elske C Gootjes; Eric P van der Stok; Cornelis Verhoef; Henk M W Verheul; Tineke E Buffart; Lotte Bakkerus; Mariette Labots; Barbara M Zonderhuis; Jurriaan B Tuynman; Martijn R Meijerink; Peter M van de Ven; Cornelis J A Haasbeek; Albert J Ten Tije; Jan-Willem B de Groot; Mathijs P Hendriks; Esther van Meerten; Joost J M E Nuyttens; Dirk J Grunhagen Journal: Oncologist Date: 2020-06-16
Authors: Francesco Fiz; Guido Costa; Nicolò Gennaro; Ludovico la Bella; Alexandra Boichuk; Martina Sollini; Letterio S Politi; Luca Balzarini; Guido Torzilli; Arturo Chiti; Luca Viganò Journal: Diagnostics (Basel) Date: 2021-06-25
Authors: Felice Giuliante; Luca Viganò; Agostino M De Rose; Darius F Mirza; Réal Lapointe; Gernot Kaiser; Eduardo Barroso; Alessandro Ferrero; Helena Isoniemi; Santiago Lopez-Ben; Irinel Popescu; Jean-Francois Ouellet; Catherine Hubert; Jean-Marc Regimbeau; Jen-Kou Lin; Oleg G Skipenko; Francesco Ardito; René Adam Journal: Ann Surg Oncol Date: 2021-07-01 Impact factor: 5.344