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Survival Benefit of and Indications for Adjuvant Chemotherapy for Resected Colorectal Liver Metastases—a Japanese Nationwide Survey

  • Shin Kobayashi
  • Toru Beppu
  • Goro Honda
  • Masakazu Yamamoto
  • Keiichi TakahashiEmail author
  • Itaru Endo
  • Kiyoshi Hasegawa
  • Kenjiro Kotake
  • Michio Itabashi
  • Yojiro Hashiguchi
  • Yoshihito Kotera
  • Katsunori Sakamoto
  • Tatsuro Yamaguchi
  • Satoshi Morita
  • Ken Tabuchi
  • Masaru Miyazaki
  • Kenichi Sugihara
Original Article
  • 145 Downloads

Abstract

Background

The survival benefit of and indications for adjuvant chemotherapy (AC) for colorectal liver metastases (CRLM) remain unclear.

Methods

Patients who were diagnosed with liver-limited CRLM between 2005 and 2007 and subsequently underwent R0 resection without preoperative chemotherapy were identified in a Japanese nationwide survey. This overall cohort was divided into synchronous and metachronous CRLM cohorts. In each of the three cohorts, the patients that were given AC were matched with those treated with surgery alone via 1:1 propensity score (PS) matching. Recurrence-free survival (RFS) and overall survival (OS) after the initial hepatectomy were compared.

Results

The median follow-up period was 79.4 months and the overall, synchronous, and metachronous cohorts included 1145, 498, and 647 patients, respectively. After the PS matching, the patients’ demographics were well balanced. AC was effective in terms of both RFS and OS in the overall cohort (RFS hazard ratio [HR] 0.784, p = 0.045; OS HR 0.716, p = 0.028) and synchronous cohort (RFS HR 0.677, p = 0.027; OS HR 0.642, p = 0.036), whereas AC was not effective in the metachronous cohort (RFS HR 0.875, p = 0.378; OS HR 0.881, p = 0.496). However, in the metachronous cohort, AC was effective in terms of OS in the subgroup that exhibited disease-free intervals of ≤ 1 year after primary tumor resection (RFS HR 0.667, p = 0.068; OS HR 0.572, p = 0.042).

Conclusion

Adjuvant chemotherapy has a survival benefit for patients with resected CRLM. Synchronous CRLM is a favorable indication for AC, whereas in metachronous CRLM, the use of AC should be individualized according to each patient’s risk factors.

Keywords

Adjuvant chemotherapy Colorectal liver metastasis Real-world data 

Notes

Acknowledgements

The operating expenses of the present study and the Joint Committee for Nationwide Survey on Colorectal Liver Metastasis were supported by the Japanese Society of Hepato-Biliary-Pancreatic Surgery and the Japanese Society for Cancer of the Colon and Rectum.

Author Contribution

Each authors have contributed to designing the concept of the study, acquisition of data, analysis and interpretation of the results, and drafting and revision of the manuscript. Each authors have also thoroughly read the final version of the manuscript, agreed to its content, and shared the responsibility of all aspects of the study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4250_MOESM1_ESM.docx (324 kb)
ESM 1 (DOCX 324 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Shin Kobayashi
    • 1
    • 2
  • Toru Beppu
    • 1
    • 3
  • Goro Honda
    • 1
    • 4
  • Masakazu Yamamoto
    • 1
    • 5
  • Keiichi Takahashi
    • 1
    • 6
    Email author
  • Itaru Endo
    • 1
    • 7
  • Kiyoshi Hasegawa
    • 1
    • 8
  • Kenjiro Kotake
    • 1
    • 9
  • Michio Itabashi
    • 1
    • 5
  • Yojiro Hashiguchi
    • 1
    • 10
  • Yoshihito Kotera
    • 1
    • 5
  • Katsunori Sakamoto
    • 1
    • 11
  • Tatsuro Yamaguchi
    • 1
    • 6
  • Satoshi Morita
    • 1
    • 12
  • Ken Tabuchi
    • 1
    • 13
  • Masaru Miyazaki
    • 14
  • Kenichi Sugihara
    • 15
  1. 1.The Joint Committee for Nationwide Survey on Colorectal Liver MetastasisTokyoJapan
  2. 2.Department of Hepatobiliary and Pancreatic SurgeryNational Cancer Center Hospital EastKashiwaJapan
  3. 3.Department of SurgeryYamaga City Medical CenterKumamotoJapan
  4. 4.Department of Gastroenterological SurgeryNew Tokyo HospitalChibaJapan
  5. 5.Department of Surgery, Institute of GastroenterologyTokyo Women’s Medical UniversityTokyoJapan
  6. 6.Department of SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
  7. 7.Department of Gastrointestinal Surgery, Graduate School of MedicineYokohama City UniversityKanagawaJapan
  8. 8.Department of Surgery, Graduate School of Medicine Hepato-Biliary-Pancreatic Surgery DivisionUniversity of TokyoTokyoJapan
  9. 9.Department of SurgerySano City HospitalTochigiJapan
  10. 10.Department of SurgeryTeikyo University School of MedicineTokyoJapan
  11. 11.Department of SurgeryEhime University HospitalEhimeJapan
  12. 12.Department of Biomedical Statistics and Bioinformatics, Graduate School of MedicineKyoto UniversityKyotoJapan
  13. 13.Department of PediatricsTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
  14. 14.Mita HospitalInternational University of Health and WelfareTokyoJapan
  15. 15.Tokyo Medical and Dental UniversityTokyoJapan

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