- •A heavier tumour burden was found in patients with colorectal liver metastases (CLM) resection after 2nd-line preoperative chemotherapy (PCT).
- •The 49% 5-year overall survival (OS) from CLM diagnosis in this group was similar to that after 1st-line.
- •OS or disease-free survival was comparable for the subsets of initially unresectable of two PCT groups.
- •Surgery of CLM may be proposed to resect CLM ever after 2nd-line chemotherapy.
Patient outcome after resection of colorectal liver metastases (CLM) following second-line preoperative chemotherapy (PCT) performed for insufficient response or toxicity of the first-line, is little known and has here been compared to the outcome following first-line.
Patients and methods
From January 2005 to June 2013, 5624 and 791 consecutive patients of a prospective international cohort received 1 and 2 PCT lines before CLM resection (group 1 and 2, respectively). Survival and prognostic factors were analysed.
After a mean follow-up of 30.1 months, there was no difference in survival from CLM diagnosis (median, 3-, and 5-year overall survival [OS]: 58.6 months, 76% and 49% in group 2 versus 58.9 months, 71% and 49% in group 1, respectively, P = 0.32). After hepatectomy, disease-free survival (DFS) was however shorter in group 2: 17.2 months, 27% and 15% versus 19.4 months, 32% and 23%, respectively (P = 0.001). Among the initially unresectable patients of group 1 and 2, no statistical difference in OS or DFS was observed. Independent predictors of worse OS in group 2 were positive primary lymph nodes, extrahepatic disease, tumour progression on second line, R2 resection and number of hepatectomies/year <50. Positive primary nodes, synchronous and bilateral metastases were predictors of shorter DFS. Initial unresectability did not impact OS or DFS in group 2.
CLM resection following second-line PCT, after oncosurgically favourable selection, could bring similar OS compared to what observed after first-line. For initially unresectable patients, OS or DFS is comparable between first- and second-line PCT. Surgery should not be denied after the failure of first-line chemotherapy.
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Published online: April 10, 2017
Accepted: March 5, 2017
Received in revised form: February 20, 2017
Received: November 29, 2016
© 2017 Elsevier Ltd. All rights reserved.