T. Ochiai1, T. Shigeno1, M. Sakano1, T. Igaki1, R. Matsumoto1, N. Chiyonobu1, I. Saito1, K. Saito1, S. Yamazaki1 1Ohta Nishinouchi General Hospital,Suregry,Koriyama, FUKUSHIMA, Japan
Introduction: Recent advances in chemotherapy have expanded the resectability of colorectal cancer with liver metastases (CRLM), optimal surgical management for the patients with CRLM is controversial. We studied treatment results in the patients with CRLM since molecular target-based agent was approved in Japan since 2008.
Methods: Based on data collected retrospectively, we analyzed the demographics, clinical data, operative findings, chemotherapy, and outcomes of 285 consecutive CRLM patients treated between 2008 and 2017. To investigate the optimal surgical management, we devided the observation periods into 2 periods, 2008-2011 and 2012-2017, and analyzed resectability and response rate of chemotherapy.
Results:The 1-, 3-, and 5-year overall survival rates for the entire CRLM patient and 109 patients who underwent liver resection were 80.4%, 48.4%, and 30.0%, and 94.3%, 72.5%, and 52.8%, respectively. Out of synchronous/metachronous, neo-adjuvant and adjuvant chemotherapy, repeat liver resection, only perioperative chemotherapy revealed significant difference in resected 109 patients. The resectability of whole CRLM was 38.2% in 2008-2017, 46.2% in 2008-2011, and 33.5% in 2012-2017. The response rate of patients with unresectable or neoadjuvant chemotherapy were 43.8% in 2008-2017, 43.1% in 2008-2011, and 45.0% in 2012-2017. The 1-, 3-, and 5-year overall survival rates for the entire CRLM patient and 101 patients who underwent liver resection were 74.8%, 48.4%, 32.6%, and 93.7%, 80.7%, 55.5% in 2008-2011, and 84.0%, 47.1%, 25.2%, and 94.9%, 71.1%, 49.5% in 2012-2017. Three cases of initially unresectable CRLM converted to complete resection with neoadjuvant chemotherapy.
Conclusion:Although development of various molecular target-based agents has improved short-term survival of CRLM patients, liver resection is the key of long-survival. Neither neoadjuvant nor adjuvant chemotherapy is not significantly different in survival, but perioperative chemotherapy is effective in this study. To improve survival of the patients with CRLM, aggressive surgery and perioperative chemotherapy without missing the timing of hepatectomy are required.
