Survival of patients with colorectal liver metastases treated with and without preoperative chemotherapy: Nationwide propensity score-matched study

Michelle R. de Graaff*, Joost M. Klaase, for Dutch Hepato Biliary Audit Group, Collaborators, Ronald M. van Dam, Koert F.D. Kuhlmann, Geert Kazemier, Rutger Jan Swijnenburg, Arthur K.E. Elfrink, Cees Verhoef, J. Sven Mieog, Peter B. van den Boezem, Paul Gobardhan, Arjen M. Rijken, Daan J. Lips, Wouter G.K. Leclercq, Hendrik A. Marsman, Peter van Duijvendijk, Joost A.B. van der Hoeven, Maarten Vermaas, Marcel den DulkDirk J. Grünhagen, Niels F.M. Kok

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Introduction: Routine treatment with preoperative systemic chemotherapy (CTx) in patients with colorectal liver metastases (CRLM) remains controversial due to lack of consistent evidence demonstrating associated survival benefits. This study aimed to determine the effect of preoperative CTx on overall survival (OS) compared to surgery alone and to assess hospital and oncological network variation in 5-year OS. Methods: This was a population-based study of all patients who underwent liver resection for CRLM between 2014 and 2017 in the Netherlands. After 1:1 propensity score matching (PSM), OS was compared between patients treated with and without preoperative CTx. Hospital and oncological network variation in 5-year OS corrected for case-mix factors was calculated using an observed/expected ratio. Results: Of 2820 patients included, 852 (30.2%) and 1968 (69.8%) patients were treated with preoperative CTx and surgery alone, respectively. After PSM, 537 patients remained in each group, median number of CRLM; 3 [IQR 2–4], median size of CRLM; 28 mm [IQR 18–44], synchronous CLRM (71.1%). Median follow-up was 80.8 months. Five-year OS rates after PSM for patients treated with and without preoperative chemotherapy were 40.2% versus 38.3% (log-rank P = 0.734). After stratification for low, medium, and high tumour burden based on the tumour burden score (TBS) OS was similar for preoperative chemotherapy vs. surgery alone (log-rank P = 0.486, P = 0.914, and P = 0.744, respectively). After correction for non-modifiable patient and tumour characteristics, no relevant hospital or oncological network variation in five-year OS was observed. Conclusion: In patients eligible for surgical resection, preoperative chemotherapy does not provide an overall survival benefit compared to surgery alone.

Original languageEnglish
Article number106932
JournalEuropean Journal of Surgical Oncology
Volume49
Issue number9
Early online date14 May 2023
DOIs
Publication statusPublished - Sept 2023

Bibliographical note

Funding Information:
The authors would like to thank all surgeons, interventional radiologists, and administrative nurses for data registration in the DHBA database, as well as the Dutch Hepato Biliary Audit Group for scientific input.

Publisher Copyright:
© 2023 The Authors

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