TY - JOUR
T1 - Local Therapy Improves Survival for Early Recurrence After Resection of Colorectal Liver Metastases
AU - Boyev, Artem
AU - Tzeng, Ching Wei D.
AU - Maki, Harufumi
AU - Arvide, Elsa M.
AU - Mrema, Deborah E.
AU - Jain, Anish J.
AU - Haddad, Antony
AU - Lendoire, Mateo
AU - Malik, Neha
AU - Odisio, Bruno C.
AU - Chun, Yun Shin
AU - Tran Cao, Hop S.
AU - Vauthey, Jean Nicolas
AU - Newhook, Timothy E.
N1 - Publisher Copyright:
© Society of Surgical Oncology 2023.
PY - 2024/4
Y1 - 2024/4
N2 - Background: Early recurrence following hepatectomy for colorectal liver metastases (CLM) is associated with worse survival; yet, impact of further local therapy is unclear. We sought to evaluate whether local therapy benefits patients with early recurrence following hepatectomy for CLM. Methods: Clinicopathologic and survival outcomes of patients managed with hepatectomy for CLM (1/2001–12/2020) were queried from a prospectively maintained database. Timing of recurrence was stratified as early (recurrence-free survival [RFS] < 6 months), intermediate (RFS 6–12 months), and later (RFS > 12 months). Local therapy was defined as ablation, resection, or radiation. Results: Of 671 patients, 541 (81%) recurred with 189 (28%) early, 180 (27%) intermediate, and 172 (26%) later recurrences. Local therapy for recurrence resulted in improved survival, regardless of recurrence timing (early 78 vs. 32 months, intermediate 72 vs. 39 months, later 132 vs. 65 months, all p < 0.001). Following recurrence, treatment with local therapy (hazard ratio [HR] = 0.24), liver and extrahepatic recurrence (HR = 1.81), RAS + TP53 co-mutation (HR = 1.52), and SMAD4 mutation (HR = 1.92) were independently associated with overall survival (all p ≤ 0.002). Among patients with recurrence treated by local therapy, patients older than 65 years (HR 1.79), liver and extrahepatic recurrence (HR 2.05), primary site or other recurrence (HR 1.90), RAS-TP53 co-mutation (HR 1.63), and SMAD4 mutation (HR 2.06) had shorter post-local therapy survival (all p ≤ 0.04). Conclusions: While most patients recur after hepatectomy for CLM, local therapy may result in long-term survival despite early recurrence. Somatic mutational profiling may help to guide the multidisciplinary consideration of local therapy after recurrence.
AB - Background: Early recurrence following hepatectomy for colorectal liver metastases (CLM) is associated with worse survival; yet, impact of further local therapy is unclear. We sought to evaluate whether local therapy benefits patients with early recurrence following hepatectomy for CLM. Methods: Clinicopathologic and survival outcomes of patients managed with hepatectomy for CLM (1/2001–12/2020) were queried from a prospectively maintained database. Timing of recurrence was stratified as early (recurrence-free survival [RFS] < 6 months), intermediate (RFS 6–12 months), and later (RFS > 12 months). Local therapy was defined as ablation, resection, or radiation. Results: Of 671 patients, 541 (81%) recurred with 189 (28%) early, 180 (27%) intermediate, and 172 (26%) later recurrences. Local therapy for recurrence resulted in improved survival, regardless of recurrence timing (early 78 vs. 32 months, intermediate 72 vs. 39 months, later 132 vs. 65 months, all p < 0.001). Following recurrence, treatment with local therapy (hazard ratio [HR] = 0.24), liver and extrahepatic recurrence (HR = 1.81), RAS + TP53 co-mutation (HR = 1.52), and SMAD4 mutation (HR = 1.92) were independently associated with overall survival (all p ≤ 0.002). Among patients with recurrence treated by local therapy, patients older than 65 years (HR 1.79), liver and extrahepatic recurrence (HR 2.05), primary site or other recurrence (HR 1.90), RAS-TP53 co-mutation (HR 1.63), and SMAD4 mutation (HR 2.06) had shorter post-local therapy survival (all p ≤ 0.04). Conclusions: While most patients recur after hepatectomy for CLM, local therapy may result in long-term survival despite early recurrence. Somatic mutational profiling may help to guide the multidisciplinary consideration of local therapy after recurrence.
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U2 - 10.1245/s10434-023-14806-4
DO - 10.1245/s10434-023-14806-4
M3 - Article
C2 - 38148351
AN - SCOPUS:85180677481
SN - 1068-9265
VL - 31
SP - 2547
EP - 2556
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 4
ER -