Adjuvant therapy after resection of colorectal liver metastases: the predictive value of the MSKCC clinical risk score in the era of modern chemotherapy

BMC Cancer

Nuh N Rahbari¹  Christoph Reissfelder¹  Henning Schulze-Bergkamen²  Dirk Jäger²  Markus W Büchler³  Jürgen Weitz¹  Moritz Koch¹ 

[1] Department of Visceral-, Thoracic and Vascular Surgery University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307 Dresden, Germany

[2] Department of Medical Oncology, National Center of Tumor Diseases, University of Heidelberg, Heidelberg, Germany

[3] Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

关键词: Liver resection;    Leucovorin;    5-FU;    FOLFIRI;    FOLFOX;    Colorectal cancer;   

Others  :  858982
DOI  :  10.1186/1471-2407-14-174

 received in 2013-08-03, accepted in 2014-02-19,  发布年份 2014

【 摘 要 】

Background

Despite introduction of effective chemotherapy protocols, it has remained uncertain, if patients with colorectal cancer (CRC) liver metastases should receive adjuvant therapy. Clinical or molecular predictors may help to select patients at high risk for disease recurrence and death who obtain a survival advantage by adjuvant chemotherapy.

Methods

A total of 297 patients with potentially curative resection of CRC liver metastases were analyzed. These patients had no neoadjuvant therapy, no extrahepatic disease and negative resection margins. The primary endpoint was overall survival. Patients’ risk status was evaluated using the Memorial Sloan-Kettering Cancer Center clinical risk score (MSKCC-CRS). Multivariable analyses were performed using Cox proportional hazard models.

Results

A total of 137 (43%) patients had a MSKCC-CRS > 2. Adjuvant chemotherapy was administered to 116 (37%) patients. Patients who received adjuvant chemotherapy were of younger age (p = 0.03) with no significant difference in the presence of multiple metastases (p = 0.72) or bilobar metastases (p = 0.08). On multivariate analysis adjuvant chemotherapy was associated with improved survival in the entire cohort (Hazard ratio 0.69; 95% confidence interval 0.69–0.98). It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23–0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57–1.43).

Conclusions

The MSKCC-CRS offers a tool to select patients for adjuvant therapy after resection of CRC liver metastases. Validation in independent patient cohorts is required.

【 授权许可】

   
2014 Rahbari et al.; licensee BioMed Central Ltd.

【 图 表 】

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