Role of Neoadjuvant Chemotherapy Before Simultaneous Resection of Colon Cancer and Liver Metastases: A Propensity-Score Matched Analysis

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2025-05-29 DOI:10.1016/j.clcc.2025.05.005

Sameh Hany Emile , Zoe Garoufalia , Rachel Gefen , Justin Dourado , Ebram Salama , Steven D. Wexner

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引用次数: 0

Abstract

Background

There has been a controversy about the optimal management of colorectal liver metastases (CLM). Both upfront surgery and neoadjuvant chemotherapy are viable options for CLM. The present study aimed to assess the short-term and survival outcomes of neoadjuvant chemotherapy before simultaneous resection of primary colon cancer and liver metastases.

Methods

This retrospective cohort study used data from the National Cancer Database (2015-2019) on patients with primary colon cancer and synchronous liver metastases. The main exposure was neoadjuvant chemotherapy before simultaneous resection of colon cancer and hepatic metastases. Propensity-score matching was used to match patients who had upfront surgery without neoadjuvant chemotherapy with patients who received neoadjuvant chemotherapy. The primary outcome was 5-year overall survival (OS). Secondary outcomes included hospital stay, 30-day and 90-day mortality, 30-day unplanned readmission, conversion to open surgery, surgical margins, and disease downstaging.

Results

Overall, neoadjuvant chemotherapy was given to 38.3% of 4060 patients. After matching, 1446 patients (53% male) were included; 482 were in the neoadjuvant group and 964 were in the no-neoadjuvant group. Neoadjuvant chemotherapy was associated with a longer restricted mean OS (46.7 vs. 40.6 months, P < .001) and significantly lower rates of 90-day mortality (3% vs. 6.5%, P = .008), 30-day unplanned readmission (4.8% vs. 8.8%, P = .002), positive surgical margins (6.5% vs. 15.1%, P < .001), and administration of adjuvant therapy (47.3% vs. 79.5%, P < .001). The 2 groups were comparable in hospital stay, 30-day mortality, and number of examined lymph nodes.

Conclusions

Giving neoadjuvant chemotherapy before simultaneous resection of colon cancer and hepatic metastases was associated with extended mean OS and reduced rates of 90-day mortality, 30-day unplanned readmission, and positive surgical margins.

查看原文本刊更多论文

结肠癌和肝转移同时切除前新辅助化疗的作用：倾向评分匹配分析。

背景：关于结肠直肠肝转移（CLM）的最佳治疗一直存在争议。前期手术和新辅助化疗都是CLM的可行选择。本研究旨在评估原发性结肠癌和肝转移同时切除前新辅助化疗的短期和生存结果。方法：本回顾性队列研究使用国家癌症数据库（2015-2019）的原发性结肠癌合并同步肝转移患者数据。主要暴露于结肠癌和肝转移同时切除前的新辅助化疗。倾向评分匹配用于将术前未进行新辅助化疗的患者与接受新辅助化疗的患者进行匹配。主要终点为5年总生存期（OS）。次要结局包括住院时间、30天和90天死亡率、30天意外再入院、转为开放手术、手术切缘和疾病分期降低。结果：4060例患者中，38.3%的患者接受了新辅助化疗。匹配后纳入1446例患者，其中男性53%；新辅助组482例，非新辅助组964例。新辅助化疗与更长的受限平均生存期（46.7个月对40.6个月，P < 0.001）、显著降低的90天死亡率（3%对6.5%,P = 0.008）、30天计划外再入院（4.8%对8.8%,P = 0.002）、阳性手术切缘（6.5%对15.1%,P < 0.001）和辅助治疗的实施（47.3%对79.5%,P < 0.001）相关。两组在住院时间、30天死亡率和检查淋巴结数量方面具有可比性。结论：在结肠癌和肝转移同时切除前给予新辅助化疗可延长平均总生存期，降低90天死亡率、30天意外再入院率和手术切缘阳性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.