Significance of postoperative adjuvant chemotherapy with an oxaliplatin-based regimen after simultaneous curative resection for colorectal cancer and synchronous colorectal liver metastasis: a propensity score matching analysis

BMC Surgery

Yuichi Tomiki¹  Yutaka Kojima¹  Kazuhiro Sakamoto¹  Makoto Takahashi¹  Kiichi Sugimoto¹  Shinya Munakata¹  Kota Amemiya²  Hiroyuki Sugo²  Yuki Ii²  Akio Saiura³  Seiji Kawasaki³  Tomoaki Ito⁴  Koichi Sato⁴ 

[1] Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan;Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan;Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan;Department of Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan;

关键词: Colorectal cancer;    Synchronous liver metastasis;    Postoperative adjuvant chemotherapy;    Oxaliplatin-based regimen;    Propensity score matching analysis;   

DOI  :  10.1186/s12893-021-01193-4

来源: Springer

【 摘 要 】

BackgroundExpansion of the indication for liver resection and new regimens for systemic chemotherapy have improved postoperative outcomes for synchronous colorectal liver metastases (CRLM). However, such cases can still have a high recurrence rate, even after curative resection. Therefore, there is a need for postoperative adjuvant chemotherapy (POAC) after liver resection in patients with CRLM. There are few studies of the efficacy of POAC with an oxaliplatin-based regimen after simultaneous resection for colorectal cancer and CRLM with curative intent. The goal of the study was to compare POAC with oxaliplatin-based and fluoropyrimidine regimens using propensity score (PS) matching analysis.MethodsThe subjects were 94 patients who received POAC after simultaneous resection for colorectal cancer and synchronous CRLM, and were enrolled retrospectively. The patients were placed in a L-OHP (+) group (POAC with an oxaliplatin-based regimen, n = 47) and a L-OHP (−) group (POAC with a fluoropyrimidine regimen, n = 47). Recurrence-free (RFS), cancer-specific (CSS), unresectable recurrence-free (URRFS), remnant liver recurrence-free (RLRFS), and extrahepatic recurrence-free (EHRFS) survival were analyzed.ResultsBefore PS matching, the L-OHP (+) and (−) groups had no significant differences in RFS, CSS, URRFS, RLRFS, and EHRFS. Univariate analysis indicated significant differences in age, preoperative serum CEA (≤ 30.0 ng/mL/ > 30.0 ng/mL), differentiation of primary tumor (differentiated/undifferentiated), T classification (T1–3/T4), number of hepatic lesions and maximum diameter of the hepatic lesion between the L-OHP (+) and (−) groups. After PS matching using these confounders, RFS was significantly better among patients in the L-OHP (+) group compared with the L-OHP (−) group (HR 0.40, 95% CI 0.17–0.96, p = 0.04). In addition, there was a trend towards better RLRFS among patients in the L-OHP (+) group compared with the L-OHP (−) group (HR 0.42, 95% CI 0.17–1.02, p = 0.055). However, there were no significant differences in CSS, URRFS and EHRFS between the L-OHP (+) and (−) groups.ConclusionsPS matching analysis demonstrated the efficacy of POAC with an oxaliplatin-based regimen in RFS and RLRFS.

【 授权许可】

CC BY