Marcello Di Martino1, Florian Primavesi2, Nicholas Syn3, Dimitri Dorcaratto4, Ángela de la Hoz Rodríguez5, Aurélien Dupré6, Tullio Piardi7, Rami Rhaiem8, Gerardo Blanco Fernández9, Arancha Prada Villaverde9, Juan C Rodríguez Sanjuán10, Roberto Fernández Santiago10, María-Carmen Fernández-Moreno4, Georgina Ferret11, Santiago López Ben11, Miguel Á Suárez Muñoz12, Alejandro J Perez-Alonso13, Ye-Xin Koh14, Robert Jones15, Elena Martín-Pérez5. 1. HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain. Electronic address: marcellodima@gmail.com. 2. Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria. 3. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. 4. Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain. 5. HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain. 6. Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; Department of Surgical Oncology, Centre Léon Bérard, Lyon, France. 7. Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France; Department of Surgery, HPB Unit, Simone Veil Hospital, Troyes, France. 8. Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France. 9. Department of HBP and Liver Transplantation Surgery, University Hospital of Badajoz, INUBE (Instituto Universitario de Investigación Biosanitaria de Extremadura), University of Extremadura, Badajoz, Spain. 10. Hospital Universitario Marqués de Valdecilla, Santander, Spain. 11. Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain. 12. Hospital Universitario Virgen de la Victoria, Malaga, Spain. 13. Unidad de Cirugia HBP y Trasplante Hepático, Hospital Universitario Virgen de las Nieves, Granada, Spain. 14. Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria. 15. Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
Abstract
BACKGROUND: There is still uncertainty regarding the role of perioperative chemotherapy (CTx) in patients with resectable colorectal liver metastases (CRLM), especially in those with a low-risk of recurrence. METHODS: Multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010-2015. Patients were divided into two groups according to whether they received perioperative CTx or not and were compared using propensity score matching (PSM) analysis. Then, they were stratified according to prognostic risk scores, including: Clinical Risk Score (CRS), Tumour Burden Score (TBS) and Genetic And Morphological Evaluation (GAME) score. RESULTS: The study included 967 patients with a median follow-up of 68 months. After PSM analysis, patients with perioperative CTx presented prolonged overall survival (OS) in comparison with the surgery alone group (82.8 vs 52.5 months, p = 0.017). On multivariable analysis perioperative CTx was an independent predictor of increased OS (HR 0.705, 95%CI 0.705-0.516, p = 0.029). The benefits of perioperative CTx on survival were confirmed in patients with CRS and TBS scores ≤2 (p = 0.022 and p = 0.020, respectively) and in patients with a GAME score ≤1 (p = 0.006). CONCLUSION: Perioperative CTx demonstrated an increase in OS in patients with CRLM. Patients with a low-risk of recurrence seem to benefit from systemic treatment.
BACKGROUND: There is still uncertainty regarding the role of perioperative chemotherapy (CTx) in patients with resectable colorectal liver metastases (CRLM), especially in those with a low-risk of recurrence. METHODS: Multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010-2015. Patients were divided into two groups according to whether they received perioperative CTx or not and were compared using propensity score matching (PSM) analysis. Then, they were stratified according to prognostic risk scores, including: Clinical Risk Score (CRS), Tumour Burden Score (TBS) and Genetic And Morphological Evaluation (GAME) score. RESULTS: The study included 967 patients with a median follow-up of 68 months. After PSM analysis, patients with perioperative CTx presented prolonged overall survival (OS) in comparison with the surgery alone group (82.8 vs 52.5 months, p = 0.017). On multivariable analysis perioperative CTx was an independent predictor of increased OS (HR 0.705, 95%CI 0.705-0.516, p = 0.029). The benefits of perioperative CTx on survival were confirmed in patients with CRS and TBS scores ≤2 (p = 0.022 and p = 0.020, respectively) and in patients with a GAME score ≤1 (p = 0.006). CONCLUSION: Perioperative CTx demonstrated an increase in OS in patients with CRLM. Patients with a low-risk of recurrence seem to benefit from systemic treatment.