Shin Kobayashi1,2, Toru Beppu1,3, Goro Honda1,4, Masakazu Yamamoto1,5, Keiichi Takahashi6,7, Itaru Endo1,8, Kiyoshi Hasegawa1,9, Kenjiro Kotake1,10, Michio Itabashi1,5, Yojiro Hashiguchi1,11, Yoshihito Kotera1,5, Katsunori Sakamoto1,12, Tatsuro Yamaguchi1,13, Satoshi Morita1,14, Ken Tabuchi1,15, Masaru Miyazaki16, Kenichi Sugihara17. 1. The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan. 2. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan. 3. Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan. 4. Department of Gastroenterological Surgery, New Tokyo Hospital, Chiba, Japan. 5. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 6. The Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan. keiichi@cick.jp. 7. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 1138677, Japan. keiichi@cick.jp. 8. Department of Gastrointestinal Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan. 9. Department of Surgery, Graduate School of Medicine Hepato-Biliary-Pancreatic Surgery Division, University of Tokyo, Tokyo, Japan. 10. Department of Surgery, Sano City Hospital, Tochigi, Japan. 11. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 12. Department of Surgery, Ehime University Hospital, Ehime, Japan. 13. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 1138677, Japan. 14. Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 15. Department of Pediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 16. Mita Hospital, International University of Health and Welfare, Tokyo, Japan. 17. Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
BACKGROUND: The survival benefit of and indications for adjuvant chemotherapy (AC) for colorectal liver metastases (CRLM) remain unclear. METHODS: Patients who were diagnosed with liver-limited CRLM between 2005 and 2007 and subsequently underwent R0 resection without preoperative chemotherapy were identified in a Japanese nationwide survey. This overall cohort was divided into synchronous and metachronous CRLM cohorts. In each of the three cohorts, the patients that were given AC were matched with those treated with surgery alone via 1:1 propensity score (PS) matching. Recurrence-free survival (RFS) and overall survival (OS) after the initial hepatectomy were compared. RESULTS: The median follow-up period was 79.4 months and the overall, synchronous, and metachronous cohorts included 1145, 498, and 647 patients, respectively. After the PS matching, the patients' demographics were well balanced. AC was effective in terms of both RFS and OS in the overall cohort (RFS hazard ratio [HR] 0.784, p = 0.045; OS HR 0.716, p = 0.028) and synchronous cohort (RFS HR 0.677, p = 0.027; OS HR 0.642, p = 0.036), whereas AC was not effective in the metachronous cohort (RFS HR 0.875, p = 0.378; OS HR 0.881, p = 0.496). However, in the metachronous cohort, AC was effective in terms of OS in the subgroup that exhibited disease-free intervals of ≤ 1 year after primary tumor resection (RFS HR 0.667, p = 0.068; OS HR 0.572, p = 0.042). CONCLUSION: Adjuvant chemotherapy has a survival benefit for patients with resected CRLM. Synchronous CRLM is a favorable indication for AC, whereas in metachronous CRLM, the use of AC should be individualized according to each patient's risk factors.
BACKGROUND: The survival benefit of and indications for adjuvant chemotherapy (AC) for colorectal liver metastases (CRLM) remain unclear. METHODS:Patients who were diagnosed with liver-limited CRLM between 2005 and 2007 and subsequently underwent R0 resection without preoperative chemotherapy were identified in a Japanese nationwide survey. This overall cohort was divided into synchronous and metachronous CRLM cohorts. In each of the three cohorts, the patients that were given AC were matched with those treated with surgery alone via 1:1 propensity score (PS) matching. Recurrence-free survival (RFS) and overall survival (OS) after the initial hepatectomy were compared. RESULTS: The median follow-up period was 79.4 months and the overall, synchronous, and metachronous cohorts included 1145, 498, and 647 patients, respectively. After the PS matching, the patients' demographics were well balanced. AC was effective in terms of both RFS and OS in the overall cohort (RFS hazard ratio [HR] 0.784, p = 0.045; OS HR 0.716, p = 0.028) and synchronous cohort (RFS HR 0.677, p = 0.027; OS HR 0.642, p = 0.036), whereas AC was not effective in the metachronous cohort (RFS HR 0.875, p = 0.378; OS HR 0.881, p = 0.496). However, in the metachronous cohort, AC was effective in terms of OS in the subgroup that exhibited disease-free intervals of ≤ 1 year after primary tumor resection (RFS HR 0.667, p = 0.068; OS HR 0.572, p = 0.042). CONCLUSION: Adjuvant chemotherapy has a survival benefit for patients with resected CRLM. Synchronous CRLM is a favorable indication for AC, whereas in metachronous CRLM, the use of AC should be individualized according to each patient's risk factors.
Entities:
Keywords:
Adjuvant chemotherapy; Colorectal liver metastasis; Real-world data