Pathologic response after preoperative therapy predicts prognosis of Chinese colorectal cancer patients with liver metastases
10.1186/s40880-017-0244-1
- Author:
Wang YUN
1
;
Yuan YUN-FEI
;
Lin HAO-CHENG
;
Li BIN-KUI
;
Wang FENG-HUA
;
Wang ZHI-QIANG
;
Ding PEI-RONG
;
Chen GONG
;
Wu XIAO-JUN
;
Lu ZHEN-HAI
;
Pan ZHI-ZHONG
;
Wan DE-SEN
;
Sun PENG
;
Yan SHU-MEI
;
Xu RUI-HUA
;
Li YU-HONG
Author Information
1. Sun Yat-sen University Cancer Center
- Keywords:
Colorectal cancer;
Liver metastases;
Chemotherapy;
Pathologic response
- From:Chinese Journal of Cancer
2017;36(11):537-547
- CountryChina
- Language:Chinese
-
Abstract:
Background: Pathologic response is evaluated according to the extent of tumor regression and is used to esti-mate the efficacy of preoperative treatment. Several studies have reported the association between the pathologic response and clinical outcomes of colorectal cancer patients with liver metastases who underwent hepatectomy. However, to date, no data from Chinese patients have been reported. In this study, we aimed to evaluate the asso-ciation between the pathologic response to pre-hepatectomy chemotherapy and prognosis in a cohort of Chinese patients. Patients and methods: In this retrospective study, we analyzed the data of 380 liver metastases in 159 patients. The pathologic response was evaluated according to the tumor regression grade (TRG). The prognostic role of pathologic response in recurrence-free survival (RFS) and overall survival (OS) was assessed using Kaplan–Meier curves with the log-rank test and multivariate Cox models. Factors that had potential influence on pathologic response were also analyzed using multivariate logistic regression and Kruskal–Wallis/Mann–WhitneyU tests. Results: Patients whose tumors achieved pathologic response after preoperative chemotherapy had significant longer RFS and OS than patients whose tumor had no pathologic response to chemotherapy (median RFS: 9.9 vs. 6.5 months,P= 0.009; median OS: 40.7 vs. 28.1 months,P= 0.040). Multivariate logistic regression and Kruskal–Wallis/Mann–WhitneyU tests showed that metastases with small diameter, metastases from the left-side primary tumors, and metastases from patients receiving long-duration chemotherapy had higher pathologic response rates than their control metastases (allP < 0.05). A decrease in the serum carcinoembryonic antigen (CEA) level after preopera-tive chemotherapy predicted an increased pathologic response rate (P < 0.05). Although the application of targeted therapy did not significantly influence TRG scores of all cases of metastases, the addition of cetuximab to chemother-apy resulted in a higher pathologic response rate when combined with irinotecan-based regimens rather than with oxaliplatin-based regimens. Conclusions: We found that the evaluation of pathologic response may predict the prognosis of Chinese colo-rectal cancer patients with liver metastases after preoperative chemotherapy. Small tumor diameter, long-duration chemotherapy, left primary tumor, and decreased serum CEA level after chemotherapy are associated with increased pathologic response rates.
