Takeda K, Sawada Y, Yabushita Y, Honma Y, Kumamoto T, Watanabe J, Matsuyama R, Kunisaki C, Misumi T, Endo I. Efficacy of neoadjuvant chemotherapy for initially resectable colorectal liver metastases: A retrospective cohort study. World J Gastrointest Oncol 2022; 14(7): 1281-1294 [PMID: 36051104 DOI: 10.4251/wjgo.v14.i7.1281]
Corresponding Author of This Article
Kazuhisa Takeda, PhD, Assistant Professor, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. kazu1968@yokohama-cu.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kazuhisa Takeda, Yu Sawada, Jun Watanabe, Chikara Kunisaki, Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
Yasuhiro Yabushita, Yuki Honma, Takafumi Kumamoto, Ryusei Matsuyama, Itaru Endo, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Jordan
Toshihiro Misumi, Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
Author contributions: Takeda K, Sawada Y, Yabushita Y, Honma Y, Kumamoto T and Watanabe J performed the research; Takeda K drafted the manuscript; Kunisaki C, Misumi T and Endo I revised the manuscript critically; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: The requirement for written informed consent was waived owing to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at kazu1968@yokohama-cu.ac.jp.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kazuhisa Takeda, PhD, Assistant Professor, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. kazu1968@yokohama-cu.ac.jp
Received: February 1, 2022 Peer-review started: February 1, 2022 First decision: April 17, 2022 Revised: April 29, 2022 Accepted: June 4, 2022 Article in press: June 4, 2022 Published online: July 15, 2022
ARTICLE HIGHLIGHTS
Research background
Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. The liver is the most common metastatic site of CRC, and hepatectomy is the mainstay of treatment for patients with colorectal liver metastases (CRLMs). Upfront hepatectomy is recommended for patients with resectable CRLMs. However, there are cases of early recurrence after upfront hepatectomy alone in the resectable CRLMs. In selected patients, neoadjuvant chemotherapy (NAC) may improve long-term survival.
Research motivation
Identifying the poor prognostic factors for upfront hepatectomy in resectable CRLMs and investigating the effectiveness of NAC are urgently needed to improve long-term survival of patients with resectable CRLMs.
Research objectives
To determine the efficacy of NAC for initially resectable CRLMs.
Research methods
Among 644 patients who underwent their first hepatectomy for CRLMs at our institution, 297 resectable cases were stratified into an upfront hepatectomy group (238 patients) and NAC group (59 patients). Poor prognostic factors for upfront hepatectomy were identified using multivariate logistic regression analysis. Propensity score matching was used, and clinical outcomes between the upfront hepatectomy and NAC groups were compared according to the number of poor prognostic factors. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test.
Research results
As independent poor prognostic factors for overall survival (OS) in the upfront hepatectomy group, preoperative carcinoembryonic antigen (CEA) levels (≥ 10 ng/mL) (P = 0.003), primary histological type (other than well/moderately differentiated) (P = 0.04), and primary lymph node metastases (≥ 1) (P = 0.04) were identified. High-risk status was defined as the presence of two or more risk factors. Fifty patients were matched in upfront hepatectomy and NAC groups respectively, after propensity score matching. Among high-risk patients, the 5-year OS rate was significantly higher in the NAC group (13 patients) than in the upfront hepatectomy group (18 patients) (100% vs 34%; P = 0.02).
Research conclusions
NAC was effective in patients with resectable CRLMs who had at least two of the following risk factors: Preoperative CEA levels (≥ 10 ng/mL), primary histological type (other than well/moderately differentiated), and lymph node metastases (≥ 1).
Research perspectives
NAC therapy may improve the prognosis of high-risk patients with resectable CRLMs.
