Identifying High-risk Patients with Synchronous Colorectal Liver Metastasis: Implications for Preoperative...

Area of Science:

• Hepatobiliary Surgery
• Colorectal Oncology
• Medical Oncology

Background:

• Preoperative chemotherapy can enhance resectability for colorectal liver metastasis (CRLM).
• Patient selection for preoperative chemotherapy in CRLM remains debated.
• Identifying high-risk CRLM patients is crucial for optimizing treatment strategies.

Purpose of the Study:

• To identify high-risk patients with synchronous CRLM.
• To compare outcomes of preoperative chemotherapy versus upfront surgery in CRLM.
• To establish criteria for selecting patients who benefit from neoadjuvant therapy.

Main Methods:

• Retrospective analysis of 215 patients undergoing liver resection for synchronous CRLM (Jan 2010-July 2019).
• Comparison of clinicopathological features and prognoses between preoperative chemotherapy and upfront surgery groups.
• Identification of independent risk factors for recurrence-free survival.

Main Results:

• No significant difference in overall or recurrence-free survival between the two groups overall.
• ≥N2 lymph node metastasis, tumor burden score >5, positive CA19-9, and KRAS mutation were independent risk factors for recurrence.
• Patients with ≥2 risk factors showed significantly higher recurrence-free survival with preoperative chemotherapy.

Conclusions:

• New criteria for identifying high-risk CRLM patients were suggested.
• Preoperative chemotherapy is a potentially effective option for high-risk CRLM patients with multiple risk factors.
• Risk stratification can guide treatment decisions in CRLM.