TY - JOUR
T1 - Survival of patients with colorectal liver metastases treated with and without preoperative chemotherapy
T2 - Nationwide propensity score-matched study
AU - de Graaff, Michelle.R.
AU - Klaase, Joost M.
AU - van Dam, Ronald M.
AU - Kuhlmann, Koert F. D.
AU - Kazemier, Geert
AU - Swijnenburg, Rutger-Jan
AU - Elfrink, Arthur K. E.
AU - Verhoef, Cees
AU - Mieog, J. Sven
AU - van den Boezem, Peter B.
AU - Gobardhan, Paul
AU - Rijken, Arjen M.
AU - Lips, Daan J.
AU - Leclercq, Wouter G. K.
AU - Marsman, Hendrik A.
AU - van Duijvendijk, Peter
AU - van der Hoeven, Joost A. B.
AU - Vermaas, Maarten
AU - Dulk, Marcel den
AU - Grünhagen, Dirk J.
AU - Kok, Niels F. M.
AU - Buis, Carlijn I.
AU - Hagendoorn, Jeroen
AU - Derksen, Wouter J. M.
AU - Torrenga, Hans
AU - Manusama, Eric
AU - Tjarda van Heek, N.
AU - Oosterling, Steven J.
AU - Bosscha, Koop
AU - Braat, Andries E.
AU - Hoogwater, Frederik J. H.
AU - for Dutch Hepato Biliary Audit Group, Collaborators
AU - Consten, Esther C. J.
AU - van der Leij, Christiaan
AU - Burgmans, Mark C.
AU - Liem, Mike S. L.
AU - Belt, Eric J. Th
AU - Patijn, Gijs A.
N1 - Funding Information: The authors would like to thank all surgeons, interventional radiologists, and administrative nurses for data registration in the DHBA database, as well as the Dutch Hepato Biliary Audit Group for scientific input. Publisher Copyright: © 2023 The Authors
PY - 2023/9
Y1 - 2023/9
N2 - Introduction: Routine treatment with preoperative systemic chemotherapy (CTx) in patients with colorectal liver metastases (CRLM) remains controversial due to lack of consistent evidence demonstrating associated survival benefits. This study aimed to determine the effect of preoperative CTx on overall survival (OS) compared to surgery alone and to assess hospital and oncological network variation in 5-year OS. Methods: This was a population-based study of all patients who underwent liver resection for CRLM between 2014 and 2017 in the Netherlands. After 1:1 propensity score matching (PSM), OS was compared between patients treated with and without preoperative CTx. Hospital and oncological network variation in 5-year OS corrected for case-mix factors was calculated using an observed/expected ratio. Results: Of 2820 patients included, 852 (30.2%) and 1968 (69.8%) patients were treated with preoperative CTx and surgery alone, respectively. After PSM, 537 patients remained in each group, median number of CRLM; 3 [IQR 2–4], median size of CRLM; 28 mm [IQR 18–44], synchronous CLRM (71.1%). Median follow-up was 80.8 months. Five-year OS rates after PSM for patients treated with and without preoperative chemotherapy were 40.2% versus 38.3% (log-rank P = 0.734). After stratification for low, medium, and high tumour burden based on the tumour burden score (TBS) OS was similar for preoperative chemotherapy vs. surgery alone (log-rank P = 0.486, P = 0.914, and P = 0.744, respectively). After correction for non-modifiable patient and tumour characteristics, no relevant hospital or oncological network variation in five-year OS was observed. Conclusion: In patients eligible for surgical resection, preoperative chemotherapy does not provide an overall survival benefit compared to surgery alone.
AB - Introduction: Routine treatment with preoperative systemic chemotherapy (CTx) in patients with colorectal liver metastases (CRLM) remains controversial due to lack of consistent evidence demonstrating associated survival benefits. This study aimed to determine the effect of preoperative CTx on overall survival (OS) compared to surgery alone and to assess hospital and oncological network variation in 5-year OS. Methods: This was a population-based study of all patients who underwent liver resection for CRLM between 2014 and 2017 in the Netherlands. After 1:1 propensity score matching (PSM), OS was compared between patients treated with and without preoperative CTx. Hospital and oncological network variation in 5-year OS corrected for case-mix factors was calculated using an observed/expected ratio. Results: Of 2820 patients included, 852 (30.2%) and 1968 (69.8%) patients were treated with preoperative CTx and surgery alone, respectively. After PSM, 537 patients remained in each group, median number of CRLM; 3 [IQR 2–4], median size of CRLM; 28 mm [IQR 18–44], synchronous CLRM (71.1%). Median follow-up was 80.8 months. Five-year OS rates after PSM for patients treated with and without preoperative chemotherapy were 40.2% versus 38.3% (log-rank P = 0.734). After stratification for low, medium, and high tumour burden based on the tumour burden score (TBS) OS was similar for preoperative chemotherapy vs. surgery alone (log-rank P = 0.486, P = 0.914, and P = 0.744, respectively). After correction for non-modifiable patient and tumour characteristics, no relevant hospital or oncological network variation in five-year OS was observed. Conclusion: In patients eligible for surgical resection, preoperative chemotherapy does not provide an overall survival benefit compared to surgery alone.
KW - Chemotherapy
KW - Colorectal liver metastases
KW - Liver surgery
KW - Overall survival
KW - Practice variation
UR - http://www.scopus.com/inward/record.url?scp=85161650258&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2023.05.007
DO - https://doi.org/10.1016/j.ejso.2023.05.007
M3 - Article
C2 - 37302900
SN - 0748-7983
VL - 49
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 9
M1 - 106932
ER -