Chemotherapy or Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer?. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Dueland, Svein; Guren, Tormod K.; Hagness, Morten; Glimelius, Bengt; Line, Pål-Dag; Pfeiffer, Per; Foss, Aksel; Tveit, Kjell M.
• Is Part Of: Annals of surgery. Volume 261:Issue 5(2015:May)
• Publication Date: 2015-05
• Subjects: chemotherapy -- colorectal cancer -- liver metastases -- liver transplantation -- overall survival; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000786
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The primary objective was to compare overall survival (OS) in patients with colorectal cancer (CRC) with nonresectable liver-only metastases treated by liver transplantation or chemotherapy. Background: CRC is the third most common cancer worldwide. About 50% of patients will develop metastatic disease primarily to the liver and the lung. The majority of patients with liver metastases receive palliative chemotherapy, with a median OS of trial patients of about 2 years, and less than 10% are alive at 5 years. Methods: Patients with nonresectable liver-only CRC metastases underwent liver transplantation in the SECA study (n = 21). Disease-free survival (DFS) and OS of patients included in the SECA study were compared with progression-free survival (PFS) and OS in a similar cohort of CRC patients with liver-only disease included in a first-line chemotherapy study, the NORDIC VII study (n = 47). PFS/DFS and OS were estimated by the Kaplan-Meier method. Results: DFS/PFS in both groups were 8 to 10 months. However, a dramatic difference in OS was observed. The 5-year OS rate was 56% in patients undergoing liver transplantation compared with 9% in patients starting first-line chemotherapy. The reason for the large difference in OS despite similar DFS/PFS is likely different metastatic patterns at relapse/progression. Relapse in the liver transplantation group was often detected as small, slowly growing lung metastases, whereas progression of nonresectable liver metastases was observed in the chemotherapy group. Conclusions: Compared with chemotherapy, liver transplantation resulted in a marked increased OS in CRC patients with nonresectable liver-only metastases. Abstract : In this study, we have compared overall survival in patients with colorectal cancer with nonresectable liver-only metastases treated by liver transplantation with a similar cohort of patients administered chemotherapy. The 5-year overall survival rate was 56% and 9% in patients undergoing liver transplantation and chemotherapy, respectively.