Annals of Surgical Oncology

, Volume 17, Issue 10, pp 2714–2719 | Cite as

Neoadjuvant Chemotherapy in Patients with Stage IV Colorectal Cancer: A Comparison of Histological Response in Liver Metastases, Primary Tumors, and Regional Lymph Nodes

  • Pascal Gervaz
  • Laura Rubbia-Brandt
  • Axel Andres
  • Pietro Majno
  • Arnaud Roth
  • Philippe Morel
  • Gilles Mentha
Gastrointestinal Oncology



We report the histopathological results of a novel “inversed” strategy designed to manage patients with colorectal cancer (CRC) who have synchronous liver metastases by using chemotherapy first, liver surgery second, and resection of the primary tumor as a final step. This study was designed to compare the response to chemotherapy in liver metastases, primary tumors, and locoregional lymph nodes.


Twenty-nine patients with stage IV CRC received a combination of oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin (OCFL) for 3–4 months. Histological response to chemotherapy was assessed by using a tumor regression grading (TRG) score based on presence of residual tumor cells and extent of fibrosis.


Median age of patients was 56 (range, 37–69) years. Primary tumor location was right colon (n = 5), left colon (n = 7), and rectum (n = 17 patients). TRG scores correlated across disease sites (Spearman correlation coefficients for TRG in the primary tumor and lymph nodes was 0.59 [P = 0.005]; for the primary tumor and metastases 0.44 [P = 0.021]; and for lymph nodes and metastases 0.58 [P = 0.006]). Complete absence or poor tumor response (TRG4/5) was significantly more frequent in primary tumors (35.7%) and locoregional lymph nodes (38%) than in liver metastases (6.9%; McNemar test, P = 0.02). Two patients had a complete pathologic response (pT0N0M0).


In patients with stage IV colorectal cancer, liver metastases exhibit a better histological response than primary tumors to OCFL neoadjuvant chemotherapy.


Liver Metastasis Irinotecan Oxaliplatin Liver Resection Complete Pathologic Response 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Pascal Gervaz
    • 1
  • Laura Rubbia-Brandt
    • 3
  • Axel Andres
    • 1
  • Pietro Majno
    • 1
    • 4
  • Arnaud Roth
    • 2
  • Philippe Morel
    • 1
  • Gilles Mentha
    • 1
    • 4
  1. 1.Department of SurgeryUniversity Hospital GenevaGenevaSwitzerland
  2. 2.Department of OncologyUniversity Hospital GenevaGenevaSwitzerland
  3. 3.Department of PathologyUniversity Hospital GenevaGenevaSwitzerland
  4. 4.Service de Chirurgie Viscérale et TransplantationHôpital Universitaire de GenèveGenevaSwitzerland

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