Background

The role of preoperative neoadjuvant chemotherapy (NAC) in patients with resectable colorectal liver metastases (CRLM) remains undetermined. This study aimed to assess the efficacy of NAC in patients with resectable CRLM, especially in high-risk subgroups for recurrence, with special reference to synchronicity and the CRLM grade in the Japanese classification system.

Methods

A retrospective analysis of a multi-institutional cohort who was diagnosed with resectable CRLM was performed. CRLM was classified into three grades (A, B, and C) according to the combination of H stage (H1: ≤ 4 lesions and ≤ 5 cm, H2: ≥ 5 lesions or > 5 cm, H3: ≥ 5 lesions and > 5 cm), nodal status of the primary tumor (pN0/1: ≤ 3 metastases, pN2: ≥ 4 metastases), and the presence of resectable extrahepatic metastases.

Results

Among 222 patients with resectable CRLM, 97 (43.7%) had synchronous CRLM. The surgical failure-free survival (SF-FS) of patients with synchronous CRLM (without NAC) was significantly worse than that of patients with metachronous CRLM (P = 0.0264). The SF-FS of patients with Grade B/C was also significantly worse than that of Grade A (P = 0.0058). Among the 53 patients with synchronous and Grade B/C CRLM, 31 were assigned to NAC, and all of them underwent liver surgery. In this high-risk subgroup, the SF-FS and OS in the NAC group were significantly better than those in the upfront surgery group (P < 0.0001 and P = 0.0004, respectively).

Conclusions

Patients with synchronous and Grade B/C CRLM could be good candidates for indication of NAC.

中文翻译：

---

新辅助化疗对高危可切除结直肠肝转移患者的疗效

背景

术前新辅助化疗 (NAC) 在可切除结直肠肝转移 (CRLM) 患者中的作用仍未确定。本研究旨在评估 NAC 在可切除 CRLM 患者中的疗效，特别是在复发高危亚组中，特别参考日本分类系统中的同步性和 CRLM 等级。

方法

对诊断为可切除 CRLM 的多机构队列进行了回顾性分析。根据H分期（H1：≤ 4个病灶且≤ 5 cm，H2：≥ 5个病灶或> 5 cm，H3：≥ 5个病灶且> 5 cm），原发肿瘤的淋巴结状态（pN0/1：≤ 3 个转移灶，pN2：≥ 4 个转移灶），以及存在可切除的肝外转移灶。

结果

在 222 名可切除 CRLM 患者中，97 名 (43.7%) 患有同步性 CRLM。同步性 CRLM（无 NAC）患者的手术无失败生存率（SF-FS）显着低于异时性 CRLM 患者（P  = 0.0264）。B/C级患者的SF-FS也显着低于A级（P  = 0.0058）。在 53 名同步和 B/C 级 CRLM 患者中，31 名被分配到 NAC，并且都接受了肝脏手术。在该高危亚组中，NAC 组的 SF-FS 和 OS 显着优于前期手术组（分别为P  < 0.0001 和P  = 0.0004）。

结论

同步和 B/C 级 CRLM 患者可能是 NAC 适应症的良好候选者。