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Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases
Surgery, 06/25/09

Neumann UP et al. – Study reports that liver resection offers a long-term survival benefit for patients with colorectal liver metastases (CRM), even when tumor growth proceeds during pre-operative chemotherapy.

Methods

Aim was to identify risk factors for poor outcome in pts with pre-operative chemotherapy of CRM
160 pts analyzed; 3 groups of patients were identified:
- 44 pts (27.5%) had a tumor response
- 20 (12.5%) showed stable disease, and
- 96 (60%) pts had tumor progression while on chemotherapy
Median f/u was 2.4 yrs; all available clinicopathologic variables possibly associated with outcome were evaluated

Results

Survival was 88%, 53%, and 37% at 1, 3, and 5 yrs
Factors associated with poor outcome:
- Noncurative resection
- Carcinoembryonic antigen levels >200 ng/ml
- Tumor grading
- Size of the largest tumor >5 cm, and
- Number of metastases
Multivariate analysis: tumor free margin and tumor grading correlated with the outcome
Tumor progression while on chemotherapy had no influence on the long-term survival