Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent
Disease progression (PD) at neoadjuvant chemotherapy for patients with colorectal liver metastases (CLMs) is considered a contraindication to hepatic resection. Our aim was to estimate the overall survival (OS) in patients undergoing surgery compared with those treated exclusively with chemotherapy...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/3/783 |
| _version_ | 1797624947866075136 |
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| author | Simone Famularo Flavio Milana Matteo Cimino Fabio Procopio Guido Costa Jacopo Galvanin Elisa Paoluzzi Tomada Francesca Margherita Bunino Angela Palmisano Matteo Donadon Guido Torzilli |
| author_facet | Simone Famularo Flavio Milana Matteo Cimino Fabio Procopio Guido Costa Jacopo Galvanin Elisa Paoluzzi Tomada Francesca Margherita Bunino Angela Palmisano Matteo Donadon Guido Torzilli |
| author_sort | Simone Famularo |
| collection | DOAJ |
| description | Disease progression (PD) at neoadjuvant chemotherapy for patients with colorectal liver metastases (CLMs) is considered a contraindication to hepatic resection. Our aim was to estimate the overall survival (OS) in patients undergoing surgery compared with those treated exclusively with chemotherapy in cases of PD. Patients from a single centre with PD were analyzed and subdivided into two groups: hepatectomy (HEP) versus chemotherapy (CHT). An Inverse Probability Weighting (IPW) was run to balance the baseline differences between the two groups. A Cox regression was carried out on identifying factors predicting mortality. From 2010 to 2020, 105 patients in PD to at least one line of chemotherapy were analyzed. Of these, 27 (25.7%) underwent hepatic resection. After a median follow-up of 30 (IQR 14–46) months, 61.9% were dead. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 95 and 46.8% for HEP (<i>p</i> < 0.001). After IPW, two balanced pseudopopulations were obtained: HEP = 85 and CHT = 103. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 97.8 and 49.3% for HEP (HR 0.256, 95%CI: 0.08–0.78, <i>p</i> = 0.033). After IPW, in the multivariate model, surgery resulted in the only protective variable (HR 0.198, 95%CI: 0.08–0.48, <i>p</i> = 0.0016). Our results show that hepatic resection could offer a chance of a longer OS than the prosecution of chemotherapy only in originally resectable patients. |
| first_indexed | 2024-03-11T09:49:53Z |
| format | Article |
| id | doaj.art-2b068872114f4dbd98b4478fc96afdb4 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T09:49:53Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-2b068872114f4dbd98b4478fc96afdb42023-11-16T16:17:10ZengMDPI AGCancers2072-66942023-01-0115378310.3390/cancers15030783Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative IntentSimone Famularo0Flavio Milana1Matteo Cimino2Fabio Procopio3Guido Costa4Jacopo Galvanin5Elisa Paoluzzi Tomada6Francesca Margherita Bunino7Angela Palmisano8Matteo Donadon9Guido Torzilli10Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDisease progression (PD) at neoadjuvant chemotherapy for patients with colorectal liver metastases (CLMs) is considered a contraindication to hepatic resection. Our aim was to estimate the overall survival (OS) in patients undergoing surgery compared with those treated exclusively with chemotherapy in cases of PD. Patients from a single centre with PD were analyzed and subdivided into two groups: hepatectomy (HEP) versus chemotherapy (CHT). An Inverse Probability Weighting (IPW) was run to balance the baseline differences between the two groups. A Cox regression was carried out on identifying factors predicting mortality. From 2010 to 2020, 105 patients in PD to at least one line of chemotherapy were analyzed. Of these, 27 (25.7%) underwent hepatic resection. After a median follow-up of 30 (IQR 14–46) months, 61.9% were dead. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 95 and 46.8% for HEP (<i>p</i> < 0.001). After IPW, two balanced pseudopopulations were obtained: HEP = 85 and CHT = 103. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 97.8 and 49.3% for HEP (HR 0.256, 95%CI: 0.08–0.78, <i>p</i> = 0.033). After IPW, in the multivariate model, surgery resulted in the only protective variable (HR 0.198, 95%CI: 0.08–0.48, <i>p</i> = 0.0016). Our results show that hepatic resection could offer a chance of a longer OS than the prosecution of chemotherapy only in originally resectable patients.https://www.mdpi.com/2072-6694/15/3/783colorectal liver metastasesliver resectiondisease progression |
| spellingShingle | Simone Famularo Flavio Milana Matteo Cimino Fabio Procopio Guido Costa Jacopo Galvanin Elisa Paoluzzi Tomada Francesca Margherita Bunino Angela Palmisano Matteo Donadon Guido Torzilli Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent Cancers colorectal liver metastases liver resection disease progression |
| title | Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent |
| title_full | Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent |
| title_fullStr | Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent |
| title_full_unstemmed | Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent |
| title_short | Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent |
| title_sort | hepatectomy versus chemotherapy for resectable colorectal liver metastases in progression after perioperative chemotherapy expanding the boundaries of the curative intent |
| topic | colorectal liver metastases liver resection disease progression |
| url | https://www.mdpi.com/2072-6694/15/3/783 |
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