Influence of neoadjuvant chemotherapy on resection of primary colorectal liver metastases: A propensity score analysis

J Surg Oncol. 2017 Aug;116(2):149-158. doi: 10.1002/jso.24631. Epub 2017 Apr 13.

Abstract

Background and objectives: There is ongoing debate about whether patients planned for liver resection of colorectal liver metastases (CRLM) benefit from neoadjuvant chemotherapy (NC). Therefore, we performed a retrospective survival analysis of patients with and without NC prior to surgery.

Methods: Data prospectively collected from 468 consecutive patients were analyzed in a retrospective design. We performed a survival analysis and added propensity score matching (PSM). Univariate and multivariate analysis was performed to determine independent prognostic risk factors.

Results: NC was performed in 145/468 patients. NC did not have a significant influence on overall survival (OS) either before or after PSM. Patients receiving NC showed increased complication rates, especially concerning non-surgical complications after primary resection (P = 0.025) of CRLM. Multivariate analysis before and after PSM revealed that the Memorial Sloan Kettering Cancer Center (MSKCC) score and CEA values are strong predictors for OS in patients with CRLM.

Conclusions: NC was not associated with increased OS in patients suffering from CRLM. Additionally, potentially harmful chemotherapy prior to surgery increases the risk of postoperative complications in these patients.

Keywords: colorectal cancer; liver; propensity score matching; survival analysis.

MeSH terms

  • Aged
  • Carcinoembryonic Antigen / blood
  • Chemotherapy, Adjuvant* / adverse effects
  • Colorectal Neoplasms / pathology*
  • Female
  • Hepatectomy
  • Humans
  • Liver Neoplasms / mortality*
  • Liver Neoplasms / secondary
  • Liver Neoplasms / therapy*
  • Lymphatic Metastasis
  • Male
  • Multivariate Analysis
  • Neoadjuvant Therapy*
  • Postoperative Complications
  • Propensity Score
  • Retrospective Studies
  • Risk Factors

Substances

  • Carcinoembryonic Antigen