Role of Neoadjuvant Chemotherapy in Resectable Synchronous Colorectal Liver Metastasis; an International Multi-Center Data Analysis Using Livermetsurvey

Background and objectivesThe use of neo-adjuvant chemotherapy in resectable synchronous liver metastasis is ill defined. The aim of this study was to evaluate neo-adjuvant chemotherapy on outcomes following liver resection for synchronous CLM. MethodsAn analysis of a multi-centric cohort from the LiverMetSurvey International Registry, who had undergone curative resections for synchronous CLM was undertaken. Patients who received neo-adjuvant chemotherapy prior to liver surgery (group NAS; n=693) were compared with those treated by surgery alone (group SG; n=608). Baseline clinicopathological variables were compared. Predictors of overall (OS) and disease free survival (DFS) were subsequently identified. ResultsClinicopathological comparison of the groups revealed a greater proportion of solitary metastasis in the SG compared to the NAS group (58.8% versus 38.4%; P<0.001) therefore a separate analysis of solitary versus multi-centric analysis was performed. N-stage (>N1), number of metastasis (>3), serum CEA (>5ng/ml) and no adjuvant chemotherapy independently predicted poorer OS, while N-stage (>N1), serum CEA (>5ng/ml) and no adjuvant chemotherapy independently predicted poorer DFS. Neo-adjuvant chemotherapy did not independently affect outcome. ConclusionWe present an analysis of a large multi-center series of the role of neo-adjuvant chemotherapy in resectable CLM and demonstrate no survival advantage in this setting. J. Surg. Oncol. 2015 111:716-724. (c) 2015 Wiley Periodicals, Inc.