Non-response to preoperative chemotherapy is a contraindication to hepatectomy plus radiofrequency ablation in patients with colorectal liver metastases
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Rui Mao1,*, Jian-Jun Zhao1,*, Hong Zhao1, Ye-Fan Zhang1, Xin-Yu Bi1, Zhi-Yu Li1, Jian-Guo Zhou1, Xiao-Long Wu1, Chen Xiao1 and Jian-Qiang Cai1
1Department of Hepatobiliary Surgery, Cancer Hospital, CAMS, Beijing 100021, P.R.China
*These authors have contributed equally to this work
Jian-Qiang Cai, email: [email protected]
Hong Zhao, email: [email protected]
Keywords: colorectal liver metastases, hepatectomy, radiofrequency ablation, preoperative chemotherapy, response
Received: July 03, 2017 Accepted: August 08, 2017 Published: September 05, 2017
The long-term outcome of 228 patients with colorectal liver metastases (CRLM) who underwent preoperative chemotherapy followed by hepatectomy ± RFA were retrospectively analyzed. Stratified by chemotherapy response, patients were divided into responding (n=129) and non-responding groups (n=99). Patients who underwent hepatectomy-RFA had a greater number of metastases (median of 4 vs. 2, p=0.000), a higher incidence of bilobar involvement (66.7% vs. 49.1%, p=0.014) and longer chemotherapy cycles (median of 6 vs. 4, p=0.000). In the responding group, the median overall survival (OS) and recurrence free survival (RFS) of hepatectomy-RFA and the hepatectomy alone subgroups were comparable (38.6 months vs. 43.2 months, p=0.824; 8.2 months vs. 11.4 months, p=0.623). In the non-responding group, the median OS and RFS of patients treated with hepatectomy-RFA were significantly shorter (18.5 months vs. 34.2 months, p=0.000; 5.1 months vs. 5.9 months, p=0.002). RFA was identified as the unfavorable independent factor for both OS (HR=3.60, 95%CI=1.81-7.16, p=0.039) and RFS (HR=1.70, 95%CI=1.00-2.86, p=0.048) in non-responsive patients. Local recurrence rate after hepatectomy-RFA was higher in the non-responding group (48.1% vs. 23.6%, p=0.018). Non-response to preoperative chemotherapy may be a contraindication to hepatectomy-RFA in patients with CRLM.
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