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The survival benefit of neoadjuvant chemotherapy for resectable colorectal liver metastases with high tumor burden score

米川, 佳彦 名古屋大学

2022.07.01

概要

Background The indications for neoadjuvant chemotherapy (NAC) in resectable colorectal liver metastases (CRLMs) remain unclear. Tumor burden score (TBS) is a prognostic tool based on tumor size and number of tumors. However, its utility in the NAC setting for initially resectable CRLM has never been investigated.

Methods TBS is a distance from the origin on a Cartesian plane to the coordinates (x, y)=(tumor size in centimeter, number of tumors). TBS<3 was defned as “TBS-low”, whereas TBS≥3 as “TBS-high”. Between 2008 and 2018, 102 patients who underwent hepatectomy for resectable CRLM were retrospectively analyzed using the Kaplan–Meier method and Cox proportional hazards regression models.

Results Among the TBS-low (n=46) and TBS-high (n=56) groups, baseline patient characteristics were mostly similar
except for TBS-related parameters. NAC was more frequently administered in the TBS-high group (p=0.038). The overall
survival (OS) rates were similar between the two groups. Subgroup analysis showed that NAC was associated with nonsignifcantly improved 5-year OS in the TBS-high group [76.1% with NAC and 54.9% without NAC (p=0.093)]. In multivariate analysis, NAC was an independent prognostic factor for favorable OS only in the TBS-high group, while adjuvant
chemotherapy (AC) was associated with improved OS only in the TBS-low group.

Conclusion In patients with resectable CRLM, the TBS-high population had a survival beneft from NAC, while the TBSlow population benefted from AC. TBS may serve as an indicator for patients who will beneft from NAC.

Keywords Liver metastases · Colorectal cancer · Tumor burden score · Neoadjuvant chemotherapy

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