M. Koss1, J. Sabbasani2, R. Thusay1, P. Silberstein1 1Creighton University Medical Center, School Of Medicine, Omaha, NE, USA 2Wright State University, School Of Medicine, Dayton, OH, USA
Introduction:
Colon cancer (CC), a leading cause of cancer-related mortality, is often treated surgically in early stages, but management of liver metastases presents new challenges. The ideal treatment sequence of combination surgical and systemic therapy remains unclear. This study aims to assess survival outcomes between different systemic and surgical therapy sequences for patients diagnosed with stage IV CC presenting with liver metastases.
Methods:
The National Cancer Database was used to identify patients over the age of 50 diagnosed with primary CC presenting with liver metastases between 2016-2020 who underwent a surgical resection and systemic therapy. These patients were then stratified based on systemic therapy and surgery sequence. Survival differences were analyzed using Kaplan-Meier and Cox regression analysis to control for differences in tumor characteristics, surgical characteristics, patient comorbidities, and demographic factors.
Results:
Analysis identified 6564 patients meeting criteria, with 806 patients receiving neoadjuvant systemic therapy, 5211 patients receiving adjuvant systemic therapy, and 547 patients receiving both neoadjuvant and adjuvant therapy in addition to surgery. Univariate analysis showed longer median survival in patients receiving systemic therapy both before and after surgery (43.890 months, 95% CI: 39.435-48.345, p<0.001) compared to median survival for patients receiving only neoadjuvant or adjuvant therapy in addition to their surgery (36.600 months, 95% CI: 34.038-39.162, p<0.001; 28.160 months, 95% CI: 27.330-28.990, p<0.001, respectively). Multivariate analysis that controlled for differences in tumor characteristics, surgical characteristics, patient comorbidities, and demographic factors showed improved survival for patients receiving both neoadjuvant and adjuvant systemic therapy (HR: 0.846, 95% CI: 0.726-0.986, p=0.032) and no significant difference in survival for patients receiving adjuvant systemic therapy (HR: 1.094, 95% CI: 0.987-1.214, p=0.087) when compared to patients receiving neoadjuvant systemic therapy.
Conclusion:
The standard sequence of care is often dependent on the specific patient situation. Selecting the appropriate sequence of care should focus on the specific patient scenario and patient goals must be closely considered and each treatment plan has its own advantages and difficulties. Based on this study, it appears that the addition of multiple phases of systemic therapy in addition to surgical resection shows improved patient survival outcomes, but further research needs to be done to account for other factors that may affect patient care and survival.