Pathologic Response to Preoperative Chemotherapy: A New Outcome End Point After Resection of Hepatic Colorectal Metastases

• Published in: Journal of clinical oncology Vol. 26; no. 33; pp. 5344 - 5351
• Main Authors: BLAZER, Dan G, KISHI, Yoji, ZORZI, Daria, RIBERO, Dario, ELLIS, Lee M, GLOVER, Katrina Y, WOLFF, Robert A, CURLEY, Steven A, ABDALLA, Eddie K, VAUTHEY, Jean-Nicolas, MARU, Dipen M, KOPETZ, Scott, YUN SHIN CHUN, OVERMAN, Michael J, FOGELMAN, David, ENG, Cathy, CHANG, David Z, HUAMIN WANG
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 20.11.2008
• Subjects: Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Biological and medical sciences; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Chemotherapy, Adjuvant; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Female; Hepatectomy; Humans; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medical sciences; Middle Aged; Organoplatinum Compounds - administration & dosage; Survival Rate; Tumors; Chemotherapy; Treatment; Cancerology; Prognosis; Surgery; Malignant tumor; Metastasis; Preoperative; Cancer; Hepatectomy
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2008.17.5299

The primary goal of this study was to evaluate whether pathologic response to chemotherapy predicts patient survival after preoperative chemotherapy and resection of colorectal liver metastases (CLM). The secondary goal of the study was to identify the clinical predictors of pathologic response. A retrospective review was performed of 305 patients who underwent preoperative irinotecan- or oxaliplatin-based chemotherapy, followed by resection of CLM. Pathologic response was systematically evaluated and reported as the mean of the percentage of cancer cells remaining within each tumor. Univariate and multivariate analyses were performed to identify the predictors of pathologic response and survival. Cumulative 5-year overall survival rates by pathologic response status were as follows: 75% complete response (no residual cancer cells), 56% major response (1% to 49% residual cancer cells), and 33% minor response (> or = 50% residual cancer cells; complete v major response, P = .037; major v minor response, P = .028). Multivariate analysis revealed that only surgical margin status (P = .050; hazard ratio [HR], 1.77) and pathologic response (major response: P = .034; HR, 4.80; minor response: P = .007; HR, 6.93) were independent predictors of survival. Multivariate analysis of the predictors of pathologic response revealed that carcinoembryonic antigen level < or = 5 ng/mL, tumor size < or = 3 cm, and chemotherapy with fluoropyrimidine plus oxaliplatin and bevacizumab were independent predictors of pathologic response. Pathologic response predicts survival after preoperative chemotherapy and resection of CLM. Degree of pathologic response represents a new outcome end point for prognosis after resection of CLM.