Hepatectomy After Progressive Disease Following Chemotherapy for Colorectal Liver Metastases: A Japanese Nationwide Cohort Study.

PURPOSE: We evaluated the postoperative outcomes of patients with progressive disease after systemic chemotherapy compared with those with controlled disease.

METHODS

This retrospective study analyzed patients from the Colorectal Cancer Liver Metastasis Database, compiled by the Joint Committee of Liver Metastases Survey from Colorectal Cancer. Patients who received chemotherapy were categorized into complete response, partial response, stable disease, and progressive disease groups and further subdivided into resected and non-resected subgroups. Survival outcomes and prognostic factors were evaluated.

RESULTS

The number of patients in the complete response/partial response, stable disease, and progressive disease groups was 867, 550, and 195, respectively. Among the progressive disease group, 111 patients (57%) underwent hepatectomy. Their postoperative 5 year overall survival rate was 42.7%, which was significantly lower than that of the resected-complete response/partial response (62.0%, p<0.001) and resected-stable disease groups (55.5%; p<0.001). However, overall survival from the date of colorectal liver metastases diagnosis of the resected-progressive disease group was better than that of the non-resected-partial response group (5 year, 46.5% vs 11.4%, p<0.001). Multivariate analysis performed on the resected-progressive disease group revealed preoperative carcinoembryonic antigen (CEA) ≥100 ng/mL and metachronous colorectal liver metastases as independent predictors of poor overall survival.

CONCLUSIONS

Although progressive disease after chemotherapy generally indicated poor prognosis, it should not be an absolute contraindication for hepatectomy. Preoperative CEA ≥100 ng/mL and metachronous colorectal liver metastases may identify a higher-risk subset and should be considered when determining surgical indications.