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



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


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.


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).


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.

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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.

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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.

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Correspondence to Keiichi Takahashi.

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Kobayashi, S., Beppu, T., Honda, G. et al. Survival Benefit of and Indications for Adjuvant Chemotherapy for Resected Colorectal Liver Metastases—a Japanese Nationwide Survey. J Gastrointest Surg 24, 1244–1260 (2020).

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  • Adjuvant chemotherapy
  • Colorectal liver metastasis
  • Real-world data