TY - JOUR
T1 - Conditional Recurrence-Free Survival after Resection of Colorectal Liver Metastases
T2 - Persistent Deleterious Association with RAS and TP53 Co-Mutation
AU - Kawaguchi, Yoshikuni
AU - Lillemoe, Heather A.
AU - Panettieri, E.
AU - Chun, Yun Shin
AU - Tzeng, Ching Wei D.
AU - Aloia, Thomas A.
AU - Kopetz, S.
AU - Vauthey, Jean Nicolas
N1 - Funding Information:
Support: This study was supported by the National Cancer Institute under award number P30 CA016672, which supports the MD Anderson Cancer Center Clinical Trials Support Resource.
Funding Information:
Support: This study was supported by the National Cancer Institute under award number P30 CA016672, which supports the MD Anderson Cancer Center Clinical Trials Support Resource. Support: This study was supported by the National Cancer Institute under award number P30 CA016672, which supports the MD Anderson Cancer Center Clinical Trials Support Resource. The authors thank Dr Mario De Bellis for reviewing the data used in the study, Ms Ruth Haynes for administrative support in the preparation of this manuscript, and Ms Stephanie Deming, an employee of the Department of Scientific Publications at MD Anderson Cancer Center, for copyediting the manuscript. Support: This study was supported by the National Cancer Institute under award number P30 CA016672, which supports the MD Anderson Cancer Center Clinical Trials Support Resource.
Publisher Copyright:
© 2019 American College of Surgeons
PY - 2019/9
Y1 - 2019/9
N2 - Background: Conditional recurrence-free survival (RFS) probability, that is, the probability of remaining recurrence-free after a given interval without recurrence, has not been reported after resection of colorectal liver metastases (CLMs). We aimed to estimate conditional RFS and identify factors affecting conditional RFS. Study Design: Patients undergoing initial resection of CLMs during 2000-2016 with mutation data were identified. The RFS and risk factors for recurrence were evaluated at the time of resection for all patients and at 1 year and 2 years after resection for patients who remained recurrence-free. Results: Of 2,118 patients, 485 met the inclusion criteria, of which 225 were recurrence-free at 1 year and 109 were recurrence-free at 2 years. The 5-year RFS rates were 17.3%, 36.8%, and 70.7% for all patients and the 1-year and 2-year recurrence-free groups, respectively, when assessed from the time of initial CLM resection. RAS/TP53 co-mutation was the only factor independently associated with increased risk of recurrence for all groups (all patients, hazard ratio 1.47; 95% CI 1.19 to 1.82; p < 0.001; 1-year recurrence-free, hazard ratio 1.69; 95% CI 1.17 to 2.43; p = 0.005; 2-year recurrence-free, hazard ratio 2.41; 95% CI 1.12 to 5.17; p = 0.024). T category, extrahepatic disease, multiple CLMs, largest CLM diameter, and surgical margin status were risk factors for recurrence in all patients and/or the 1-year recurrence-free group, but not the 2-year recurrence-free group. Median RFS was lower for patients with RAS/TP53 co-mutation than for those with RAS/TP53 wild-type in the 1-year (1.5 vs 2.8 years; p = 0.006) and 2-year recurrence-free groups (3.0 vs 5.9 years; p = 0.024). Conclusions: Conditional RFS is useful for updating prognosis after a given time interval without recurrence after CLM resection. Importantly, RAS/TP53 co-mutation has a persistent deleterious association with recurrence.
AB - Background: Conditional recurrence-free survival (RFS) probability, that is, the probability of remaining recurrence-free after a given interval without recurrence, has not been reported after resection of colorectal liver metastases (CLMs). We aimed to estimate conditional RFS and identify factors affecting conditional RFS. Study Design: Patients undergoing initial resection of CLMs during 2000-2016 with mutation data were identified. The RFS and risk factors for recurrence were evaluated at the time of resection for all patients and at 1 year and 2 years after resection for patients who remained recurrence-free. Results: Of 2,118 patients, 485 met the inclusion criteria, of which 225 were recurrence-free at 1 year and 109 were recurrence-free at 2 years. The 5-year RFS rates were 17.3%, 36.8%, and 70.7% for all patients and the 1-year and 2-year recurrence-free groups, respectively, when assessed from the time of initial CLM resection. RAS/TP53 co-mutation was the only factor independently associated with increased risk of recurrence for all groups (all patients, hazard ratio 1.47; 95% CI 1.19 to 1.82; p < 0.001; 1-year recurrence-free, hazard ratio 1.69; 95% CI 1.17 to 2.43; p = 0.005; 2-year recurrence-free, hazard ratio 2.41; 95% CI 1.12 to 5.17; p = 0.024). T category, extrahepatic disease, multiple CLMs, largest CLM diameter, and surgical margin status were risk factors for recurrence in all patients and/or the 1-year recurrence-free group, but not the 2-year recurrence-free group. Median RFS was lower for patients with RAS/TP53 co-mutation than for those with RAS/TP53 wild-type in the 1-year (1.5 vs 2.8 years; p = 0.006) and 2-year recurrence-free groups (3.0 vs 5.9 years; p = 0.024). Conclusions: Conditional RFS is useful for updating prognosis after a given time interval without recurrence after CLM resection. Importantly, RAS/TP53 co-mutation has a persistent deleterious association with recurrence.
UR - http://www.scopus.com/inward/record.url?scp=85066792185&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066792185&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2019.04.027
DO - 10.1016/j.jamcollsurg.2019.04.027
M3 - Article
C2 - 31054911
AN - SCOPUS:85066792185
SN - 1072-7515
VL - 229
SP - 286-294.e1
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
ER -