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Outcomes of Mixed Pathologic Response in Patients with Multiple Colorectal Liver Metastases Treated with Neoadjuvant Chemotherapy and Liver Resection

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pathologic response to preoperative chemotherapy predicts survival in patients with colorectal liver metastases (CLMs) who undergo hepatectomy. In multiple CLMs, mixed pathologic response, wherein tumors exhibit different degrees of treatment response, is possible. We sought to evaluate survival outcomes of mixed response in patients with multiple CLMs.

Methods

We conducted a retrospective cohort study using a single-institution database of patients with two or more CLMs who underwent preoperative chemotherapy and hepatectomy (2010–2018). Pathologic response of each tumor was measured on pathology. Patients were stratified by pathologic response as complete (pCR) = 0–1% viability; major (pMajR) = 2–49% viability; minor (pMinR) = 50–99% viability; or mixed (pMixR) = at least one pCR/MajR tumor and one pMinR. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan–Meier method, and adjusted risk of death was evaluated using Cox regression.

Results

Among 444 patients, 6% had pCR, 34% had pMajR, 36% had pMinR, and 24% had pMixR. Median and 5-year RFS for patients with pMixR was 10.4 months and 16%, respectively, compared with pMajR (11.3 months and 18%, respectively), pMinR (7.7 months and 13%, respectively), and pCR (23.1 months and 38%, respectively) [log-rank p < 0.001]. Median and 5-year OS for patients with pMixR was 77.4 months and 60%, respectively, compared with pMajR (80.5 months and 63%, respectively), pMinR (49.9 months and 39%, respectively), and pCR (median OS not reached; median follow-up of 37.1 months and 5-year OS of 65%) [log-rank p = 0.002]. pMixR was associated with a 52% risk of death reduction (hazard ratio 0.48, 95% confidence interval 0.30–0.78 vs. pMinR).

Conclusions

One-quarter of patients with multiple CLMs have pMixR following preoperative chemotherapy and hepatectomy. OS and RFS for patients with pMixR mirror those of pMajR rather than pMinR, suggesting the greatest response achieved in any metastasis best predicts survival.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Meredith C. Mason MD

  2. Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland

    Maciej Krasnodebski PhD

  3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Caitlin A. Hester MD, Caeli Barker PA-C, Yujiro Nishioka PhD, Yi-Ju Chiang MSPH, Timothy E. Newhook MD, Ching-Wei D. Tzeng MD, Yun Shin Chun MD, Jean-Nicolas Vauthey MD & Hop S. Tran Cao MD

  4. Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Anai N. Kothari MD, MS

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Contributions

Hop S. Tran Cao and Meredith C. Mason conceived the study concept and design and prepared the manuscript. Yi-Ju Chiang had access to the data and completed all statistical analyses. All authors contributed to the study’s interpretation, review, and manuscript approval.

Corresponding author

Correspondence to Hop S. Tran Cao MD.

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Conflict of interest

Meredith C. Mason, Maciej Krasnodebski, Caitlin A. Hester, Anai N. Kothari, Caeli Barker, Yujiro Nishioka, Yi-Ju Chiang, Timothy E. Newhook, Ching-Wei D. Tzeng, Yun Shin Chun, Jean-Nicolas Vauthey, and Hop S. Tran Cao have no conflicts of interest to disclose.

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The funding body played no part in the design and/or general conduct of this study, had no access to the data or role in data collection, management, analysis, or interpretation, and had no role in the preparation, review, or approval of this manuscript.

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Mason, M.C., Krasnodebski, M., Hester, C.A. et al. Outcomes of Mixed Pathologic Response in Patients with Multiple Colorectal Liver Metastases Treated with Neoadjuvant Chemotherapy and Liver Resection. Ann Surg Oncol 29, 5156–5164 (2022). https://doi.org/10.1245/s10434-022-11683-1

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