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Efficacy of neoadjuvant chemotherapy in patients with high-risk resectable colorectal liver metastases

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Abstract

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.

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Acknowledgements

We thank all the patients and the investigators involved in this study.

Funding

This study received no financial support.

Author information

Authors and Affiliations

  1. Department of Liver Surgery, Fukuoka City Hospital, Fukuoka, 812-0046, Japan

    Mizuki Ninomiya, Hidefumi Higashi & Hiroyuki Kuwano

  2. Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan

    Yasunori Emi, Takashi Motomura & Tomohiro Iguchi

  3. Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan

    Takahiro Tomino & Takashi Nishizaki

  4. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hiroto Kayashima, Noboru Harada & Hideaki Uchiyama

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  1. Mizuki Ninomiya
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Correspondence to Mizuki Ninomiya.

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The authors declare no conflict of interests for this article.

Ethical approval

This study was approved by the Institutional Review Board in each institution (approval number: 789, 2019–9-7 and 204).

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Supplementary Information

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10147_2021_2024_MOESM1_ESM.jpg

Supplementary file1 Supplementary Figure 1. Kaplan-Meier curves of the SF-FS in patients with (A) synchronous Grade A CRLM, (B) metachronous Grade A CRLM, (C) metachronous Grade B/C CRLM. Comparison between the NAC and Upfront surgery groups. SF-FS, surgical failure-free survival; NAC, neoadjuvant chemotherapy (JPG 1200 KB)

10147_2021_2024_MOESM2_ESM.jpg

Supplementary file2 Supplementary Figure 2. Kaplan-Meier curves of the SF-FS in patients with Grade B subgroups. Comparison between H2 and pN0/1 subgroup and H1 and pN2 subgroup in synchronous (A) and metachronous (B) CRLM patients, and comparison between NAC and Upfront surgery group in H1 and pN2 subgroup (C) and H2 and pN0/1 subgroup (D). SF-FS, surgical failure-free survival; NAC, neoadjuvant chemotherapy. (JPG 941 KB)

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Ninomiya, M., Emi, Y., Motomura, T. et al. Efficacy of neoadjuvant chemotherapy in patients with high-risk resectable colorectal liver metastases. Int J Clin Oncol 26, 2255–2264 (2021). https://doi.org/10.1007/s10147-021-02024-5

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  • DOI: https://doi.org/10.1007/s10147-021-02024-5

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