Journal
CLINICAL COLORECTAL CANCER
Volume 19, Issue 3, Pages E140-E150Publisher
CIG MEDIA GROUP, LP
DOI: 10.1016/j.clcc.2020.03.004
Keywords
Bevacizumab; Liver resection; Metastatic colorectal cancer; Perioperative chemotherapy; Resectable
Categories
Funding
- Roche [4-2012-0166]
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It remains controversial whether patients with resectable colorectal liver metastases gain a survival benefit from perioperative chemotherapy with bevacizumab. We found that the overall survival was improved, but it did not affect progression-free survival from our randomized clinical trial. Patients with high carcinoembryonic antigen levels or over 2 liver metastases may benefit from the overall survival of perioperative chemotherapy. Introduction: Whether patients with resectable colorectal liver metastases (CRLM) gain a survival benefit from perioperative chemotherapy remains controversial. The benefit of including bevacizumab in chemotherapy also remains unclear. Material and Methods: Seventy-six patients with CRLM were randomly assigned to either 6 cycles of FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin)/FOLFIRI (folinic acid, 5-fluorouracil, and irinotecan) with bevacizumab before and after surgery or 12 cycles after surgery. Progression-free survival (PFS) was estimated using the Kaplan-Meier method and compared by the log-rank test. Results: The median PFS of all patients was 37.4 months at 5.4 years follow-up, and the median overall survival (OS) was not reached. The PFS between the perioperative group and the postoperative group did not reveal a statistical difference (P = .280). The OS was significantly better in the perioperative group (hazard ratio [HR], 0.60; 95% confidence interval [CI],) 0.35-1.02; P = .049). In subgroup patients with carcinoembryonic antigens (CEA) >= 5 ng/mL or those with over 2 liver metastases, perioperative group had longer OS than postoperative group (CEA: HR, 0.49; 95% CI, 0.25-0.93; P = .030; number of livermetastases: HR, 0.55; 95% CI, 0.30-0.99; P = .049). The largest liver metastases size, disease-free interval, and sidedness did not affect PFS or OS. There was no difference between the 2 groups in postoperative complications with bevacizumab or adverse events during chemotherapy. Conclusions: In patients with resectable CRLMs, perioperative chemotherapy had no effect on PFS, but improved OS. Patients with high CEA levels or over 2 liver metastases may benefit from perioperative chemotherapy. (C) 2020 The Author(s). Published by Elsevier Inc.
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