Efficacy of upfront hepatectomy without neoadjuvant chemotherapy for resectable colorectal liver metastasis

• Published in: World journal of surgical oncology 2021-04, Vol.19 (1), p.97-97, Article 97
• Main Authors: Ono, Kosuke, Abe, Tomoyuki, Oshita, Akihiko, Sumi, Yusuke, Yano, Takuya, Okuda, Hiroshi, Kurayoshi, Manabu, Kobayashi, Tsuyoshi, Ohdan, Hideki, Noriyuki, Toshio, Nakahara, Masahiro
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Antigens; Beppu’s nomogram score; Cancer; Cancer therapies; Care and treatment; Chemotherapy; Chemotherapy, Adjuvant; Classification; Colorectal cancer; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - surgery; Complications and side effects; Development and progression; Evaluation; Hepatectomy; Humans; Laparoscopy; Liver; Liver Neoplasms - drug therapy; Liver Neoplasms - surgery; Liver tumors; Lymph nodes; Lymphatic system; Medical prognosis; Metastases; Metastasis; Multivariate analysis; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Nomograms; Nomography (Mathematics); Patients; Prognosis; Retrospective Studies; Risk analysis; Risk factors; Surgery; Survival; Tumors; Ultrasonic imaging
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-021-02210-9

Hepatectomy for resectable colorectal liver metastasis (CRLM) is recommended. However, the efficacy of upfront hepatectomy without neoadjuvant chemotherapy (NAC) is unclear due to the uncertainty of perioperative systemic chemotherapy. Moreover, it is crucial to predict the prognosis when considering perioperative chemotherapy. This study evaluated the impact of neoadjuvant chemotherapy on the prognosis of patients with resectable CRLM and assessed the usefulness of Beppu's nomogram for predicting prognosis. This retrospective study identified 88 consecutive inpatients who underwent primary hepatic resection for CRLM; 58 received neoadjuvant chemotherapy and 30 underwent upfront surgery. Factors associated with recurrence-free survival were identified via univariate and multivariate analysis. Furthermore, propensity score analysis using inverse probability of treatment weighting (IPTW) was performed. On univariate analysis, poor recurrence-free survival was associated with multiple tumors, advanced primary tumor stage, vascular invasion by the primary tumor, a Beppu's nomogram score ≥ 6, and neoadjuvant chemotherapy. On multivariate analysis, a Beppu's nomogram score ≥ 6 and neoadjuvant chemotherapy were independent risk factors for recurrence. Neoadjuvant chemotherapy recipients had a higher incidence of lymph node metastasis and vascular invasion than non-recipients. Propensity score analysis revealed no significant difference in the recurrence-free survival rate between these groups. Our results show that upfront hepatectomy without neoadjuvant chemotherapy can be considered for resectable CRLM treatment. Beppu's nomogram score can be a tool for predicting the prognosis of patients with CRLM.