Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2022; 14(7): 1281-1294
Published online Jul 15, 2022. doi: 10.4251/wjgo.v14.i7.1281
Efficacy of neoadjuvant chemotherapy for initially resectable colorectal liver metastases: A retrospective cohort study
Kazuhisa Takeda, Yu Sawada, Yasuhiro Yabushita, Yuki Honma, Takafumi Kumamoto, Jun Watanabe, Ryusei Matsuyama, Chikara Kunisaki, Toshihiro Misumi, Itaru Endo
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
Abstract
BACKGROUND

The liver is the most common metastatic site of colorectal cancer. Hepatectomy is the mainstay of treatment for patients with colorectal liver metastases (CRLMs). However, there are cases of early recurrence after upfront hepatectomy alone. In selected high-risk patients, neoadjuvant chemotherapy (NAC) may improve long-term survival.

AIM

To determine the efficacy of NAC for initially resectable CRLMs.

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 a NAC group (59 patients). Poor prognostic factors for upfront hepatectomy were identified using multivariate logistic regression analysis. Propensity score matching was used to compare clinical outcomes between the upfront hepatectomy and NAC groups, according to the number of poor prognostic factors. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test.

RESULTS

Preoperative carcinoembryonic antigen 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 as independent poor prognostic factors for overall survival (OS) in the upfront hepatectomy group. High-risk status was defined as the presence of two or more risk factors. After propensity score matching, 50 patients were matched in each group. 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).

CONCLUSION

NAC may improve the prognosis of high-risk patients with resectable CRLMs who have two or more risk factors.

Keywords: Colorectal neoplasms, Neoadjuvant therapy, Neoplasm metastasis, Prognosis, Risk factors, Survival

Core Tip: Hepatectomy is the mainstay of treatment for patients with colorectal liver metastases (CRLMs). However, there are cases of early recurrence after upfront hepatectomy alone. In selected high-risk patients, neoadjuvant chemotherapy (NAC) may improve long-term survival. Although several studies have identified risk factors for recurrence and prognosis after hepatectomy for CRLMs, they could not show a benefit of NAC for resectable CRLMs. This article demonstrated the effectiveness of NAC for initially resectable CRLMs, based on risk stratification according to prognostic factors.