Management of Patients with Colorectal Liver Metastasis Harboring More Than 5 Multiple Tumors
Authors: Ichida Kosuke, Suzuki Koichi, Kato Takaharu, Muto Yuta, Fukui Taro, Takayama Yuji, Watanabe Fumiaki, Tsujinaka Shingo, Sasaki Junichi, Noda Hiroshi, Horie Hisanaga, Rikiyama Toshiki
Journal: Annals of Oncology (2014)

Introduction: The combination of chemotherapy and surgery is currently accepted for the treatment of patients with initially unresectable colorectal liver metastasis. Due to no clear definition for respectability, it is hard to determine which way of chemotherapy or surgery should forward for the treatment of patients with more than 5 multiple liver metastases.Methods: We present a retrospective review of 140 consecutive metastatic colorectal cancer (mCRC) patients with liver tumors, who were treated in advance with chemotherapy or surgery. The recurrence free survival (RFS), progression free survival (PFS) and overall survival (OS) were assessed and compared between patients with chemotherapy and surgery according to the number of metastatic liver tumors. In addition, ratio of size in largest to smallest tumor was calculated in patients with more than 5 tumors, two groups classified according to the ratio, R < 5 (ratio is less than 5 times) and R ≥ 5 (equal or more than 5 times), were compared.Results: Sixty-seven patients were treated in advance with chemotherapy while 73 patients with surgery. In patients treated with chemotherapy, 36 patients had 4 or less than 4 liver tumors (C ≤ 4), 15 patients had 5 to 8 liver tumors (C5-8) and 16 patients had more than 9 liver tumors (C ≥ 9). In patients treated with surgery, 59 patients had 4 or less than 4 liver tumors (S ≤ 4), 11 patients had 5 to 8 liver tumors (S5-8). In patients treated with chemotherapy, the median PFS was 5.8 months in C ≤ 4, 7.3 months in C5-8 and 2.4 months in C ≥ 9. In patients treated with surgery, the median RFS was 14.0 months in S ≤ 4, 7.0 months in S5-8. Patients with 4 or less than 4 liver tumors treated with surgery had better survival (p < 0.0001) than others, but no difference in survival was seen in other 4 groups. Regarding OS, in patients treated with chemotherapy, the median OS was 17.9 months in C ≤ 4, 16.3 months in C5-8 and 10.7 months in C ≥ 9. In patients treated with surgery, the median OS was 38.0 months in S ≤ 4, 21.0 months in S5-8. Patients with 4 or less than 4 liver tumors treated with surgery had better OS (p = 0.0001) than others, but no difference in survival was seen in other 4 groups. Then, patients with more than 5 multiple liver metastases (C5-8 and S5-8) were assessed by comparing of treatment between chemotherapy and surgery but no difference in intervals to recurrence or progression was found. Next, patients were divided into two groups according to the ratio, R < 5 and R ≥ 5. In patients harboring tumors with R < 5, patients treated by surgery likely showed better RFS and OS whereas no difference in intervals to recurrence or progression and OS were seen between patients harboring tumors with R ≥ 5, regardless of treatment.Conclusion: In mCRC patients with more than 5 multiple liver tumors, biological behavior including latent metastasis may be different in tumors with R < 5 and R ≥ 5. Due to no difference in outcome by surgery or chemotherapy for those patients with R ≥ 5, chemotherapy could be better alternative to evaluate chemo-sensitivity. Introduction: The combination of chemotherapy and surgery is currently accepted for the treatment of patients with initially unresectable colorectal liver metastasis. Due to no clear definition for respectability, it is hard to determine which way of chemotherapy or surgery should forward for the treatment of patients with more than 5 multiple liver metastases. Methods: We present a retrospective review of 140 consecutive metastatic colorectal cancer (mCRC) patients with liver tumors, who were treated in advance with chemotherapy or surgery. The recurrence free survival (RFS), progression free survival (PFS) and overall survival (OS) were assessed and compared between patients with chemotherapy and surgery according to the number of metastatic liver tumors. In addition, ratio of size in largest to smallest tumor was calculated in patients with more than 5 tumors, two groups classified according to the ratio, R < 5 (ratio is less than 5 times) and R ≥ 5 (equal or more than 5 times), were compared. Results: Sixty-seven patients were treated in advance with chemotherapy while 73 patients with surgery. In patients treated with chemotherapy, 36 patients had 4 or less than 4 liver tumors (C ≤ 4), 15 patients had 5 to 8 liver tumors (C5-8) and 16 patients had more than 9 liver tumors (C ≥ 9). In patients treated with surgery, 59 patients had 4 or less than 4 liver tumors (S ≤ 4), 11 patients had 5 to 8 liver tumors (S5-8). In patients treated with chemotherapy, the median PFS was 5.8 months in C ≤ 4, 7.3 months in C5-8 and 2.4 months in C ≥ 9. In patients treated with surgery, the median RFS was 14.0 months in S ≤ 4, 7.0 months in S5-8. Patients with 4 or less than 4 liver tumors treated with surgery had better survival (p < 0.0001) than others, but no difference in survival was seen in other 4 groups. Regarding OS, in patients treated with chemotherapy, the median OS was 17.9 months in C ≤ 4, 16.3 months in C5-8 and 10.7 months in C ≥ 9. In patients treated with surgery, the median OS was 38.0 months in S ≤ 4, 21.0 months in S5-8. Patients with 4 or less than 4 liver tumors treated with surgery had better OS (p = 0.0001) than others, but no difference in survival was seen in other 4 groups. Then, patients with more than 5 multiple liver metastases (C5-8 and S5-8) were assessed by comparing of treatment between chemotherapy and surgery but no difference in intervals to recurrence or progression was found. Next, patients were divided into two groups according to the ratio, R < 5 and R ≥ 5. In patients harboring tumors with R < 5, patients treated by surgery likely showed better RFS and OS whereas no difference in intervals to recurrence or progression and OS were seen between patients harboring tumors with R ≥ 5, regardless of treatment. Conclusion: In mCRC patients with more than 5 multiple liver tumors, biological behavior including latent metastasis may be different in tumors with R < 5 and R ≥ 5. Due to no difference in outcome by surgery or chemotherapy for those patients with R ≥ 5, chemotherapy could be better alternative to evaluate chemo-sensitivity.