The Role of Chemotherapy in Patients with Synchronous Colorectal Liver Metastases: A Nationwide Study.

IF 4.5 2区医学 Q1 ONCOLOGY

Cancers Pub Date : 2025-03-13 DOI:10.3390/cancers17060970

Hanna Sternby, Farima Brandt, Srinivas Sanjeevi, Jon Unosson, Souheil Reda, Carolina Muszynska, Jozef Urdzik, Petter Frühling

{"title":"The Role of Chemotherapy in Patients with Synchronous Colorectal Liver Metastases: A Nationwide Study.","authors":"Hanna Sternby, Farima Brandt, Srinivas Sanjeevi, Jon Unosson, Souheil Reda, Carolina Muszynska, Jozef Urdzik, Petter Frühling","doi":"10.3390/cancers17060970","DOIUrl":null,"url":null,"abstract":"Background/objectives: There is still no consensus as to whether patients with upfront resectable synchronous colorectal liver metastases (sCRLM) should receive neoadjuvant treatment prior to liver surgery. Two randomized controlled trials have assessed the role of peri-operative chemotherapy in sCRLM; neither have shown a survival benefit in the neoadjuvant group. The aim of this population-based study was to examine overall survival in patients treated with neoadjuvant chemotherapy and hepatectomy compared to patients who had upfront surgery.Methods: This is a retrospective observational study between 2009 and 2017 containing data extracted from two Swedish national registries. Descriptive statistics and Cox regression analyses were employed.Results: In total, 2072 patients with sCRLM were treated with liver surgery between 2009 and 2017. A majority (n = 1238, 60%) were treated with neoadjuvant chemotherapy, and 834 patients (40%) had upfront surgery. Patients in the upfront surgery group were older (median age 70 compared to 65 years, p ≤ 0.001). Median overall survival in the upfront surgery group was 26 months (95% CI 23-29 months) compared to 57 months (95% CI 42-48 months) in the neoadjuvant group, log rank p ≤ 0.001. In the multivariable Cox regression analysis, age ≥ 70 years (HR 1.46, 95% CI 1.25-1.70), T category of primary cancer (HR 1.41, 95% CI 1.09-1.84), lymphatic spread of primary cancer (HR 1.68, 95% CI 1.41-1.99), and number of liver metastases (six or more metastases resulted in HR 2.05, 95% CI 1.38-3.01) negatively influenced overall survival. By contrast, adjuvant therapy was protective (HR 0.80, 95% CI 0-69-0.94), whereas neoadjuvant treatment compared to upfront surgery did not influence overall survival (HR 1.04, 95% CI 0.86-1.26).Conclusions: Neoadjuvant treatment in sCRLM did not confer a survival benefit compared to upfront surgery.","PeriodicalId":9681,"journal":{"name":"Cancers","volume":"17 6","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11940559/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancers","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/cancers17060970","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background/objectives: There is still no consensus as to whether patients with upfront resectable synchronous colorectal liver metastases (sCRLM) should receive neoadjuvant treatment prior to liver surgery. Two randomized controlled trials have assessed the role of peri-operative chemotherapy in sCRLM; neither have shown a survival benefit in the neoadjuvant group. The aim of this population-based study was to examine overall survival in patients treated with neoadjuvant chemotherapy and hepatectomy compared to patients who had upfront surgery.

Methods: This is a retrospective observational study between 2009 and 2017 containing data extracted from two Swedish national registries. Descriptive statistics and Cox regression analyses were employed.

Results: In total, 2072 patients with sCRLM were treated with liver surgery between 2009 and 2017. A majority (n = 1238, 60%) were treated with neoadjuvant chemotherapy, and 834 patients (40%) had upfront surgery. Patients in the upfront surgery group were older (median age 70 compared to 65 years, p ≤ 0.001). Median overall survival in the upfront surgery group was 26 months (95% CI 23-29 months) compared to 57 months (95% CI 42-48 months) in the neoadjuvant group, log rank p ≤ 0.001. In the multivariable Cox regression analysis, age ≥ 70 years (HR 1.46, 95% CI 1.25-1.70), T category of primary cancer (HR 1.41, 95% CI 1.09-1.84), lymphatic spread of primary cancer (HR 1.68, 95% CI 1.41-1.99), and number of liver metastases (six or more metastases resulted in HR 2.05, 95% CI 1.38-3.01) negatively influenced overall survival. By contrast, adjuvant therapy was protective (HR 0.80, 95% CI 0-69-0.94), whereas neoadjuvant treatment compared to upfront surgery did not influence overall survival (HR 1.04, 95% CI 0.86-1.26).

Conclusions: Neoadjuvant treatment in sCRLM did not confer a survival benefit compared to upfront surgery.

查看原文本刊更多论文

化疗在同步结直肠肝转移患者中的作用：一项全国性研究。

背景/目的：对于前期可切除的同步结直肠肝转移（sCRLM）患者是否应在肝手术前接受新辅助治疗仍未达成共识。两项随机对照试验评估了围手术期化疗在sCRLM中的作用；在新辅助治疗组中，没有显示出生存获益。这项以人群为基础的研究的目的是比较接受新辅助化疗和肝切除术的患者与接受前期手术的患者的总生存率。方法：这是一项2009年至2017年的回顾性观察性研究，包含从两个瑞典国家登记处提取的数据。采用描述性统计和Cox回归分析。结果：2009年至2017年，总共有2072例sCRLM患者接受了肝脏手术治疗。大多数（n = 1238, 60%）患者接受了新辅助化疗，834例（40%）患者接受了术前手术。术前手术组患者年龄较大（中位年龄70岁，中位年龄65岁，p≤0.001）。术前手术组的中位总生存期为26个月（95% CI 23-29个月），而新辅助组的中位总生存期为57个月（95% CI 42-48个月），log rank p≤0.001。在多变量Cox回归分析中，年龄≥70岁（HR 1.46, 95% CI 1.25-1.70）、原发癌的T类（HR 1.41, 95% CI 1.09-1.84）、原发癌的淋巴扩散（HR 1.68, 95% CI 1.41-1.99）和肝转移的数量（6个或更多的转移导致HR 2.05, 95% CI 1.38-3.01）对总生存率有负面影响。相比之下，辅助治疗具有保护作用（HR 0.80, 95% CI 0-69-0.94），而与前期手术相比，新辅助治疗对总生存率没有影响（HR 1.04, 95% CI 0.86-1.26）。结论：与前期手术相比，sCRLM的新辅助治疗并没有获得生存益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cancers Medicine-Oncology

CiteScore

8.00

自引率

9.60%

发文量

5371

审稿时长

18.07 days

期刊介绍： Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.