Details

Autor(en) / Beteiligte

• Oshi, Masanori
• Margonis, Georgios Antonios
• Sawada, Yu
• Andreatos, Nikolaos
• He, Jin
• Kumamoto, Takafumi
• Morioka, Daisuke
• Wolfgang, Christopher Lee
• Tanaka, Kuniya
• Weiss, Matthew John
• Endo, Itaru

Titel

Higher Tumor Burden Neutralizes Negative Margin Status in Hepatectomy for Colorectal Cancer Liver Metastasis

Ist Teil von

• Annals of surgical oncology, 2019-02, Vol.26 (2), p.593-603

Ort / Verlag

Cham: Springer International Publishing

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Objective The aim of this study was to examine if the prognostic significance of margin status in hepatectomy for colorectal cancer liver metastasis (CRLM) varies for different levels of tumor burden because hepatectomy indications for CRLM have been recently expanded to include patients with a higher tumor burden in whom achieving an R0 resection is difficult. Methods Clinicopathological variables in an exploration cohort of 290 patients receiving hepatectomy in Japan for CRLM were investigated. R0 resection was defined as a margin width > 0 mm. Tumor burden was assessed using the recently introduced Tumor Burden Score (TBS), which was calculated as TBS 2  = (maximum tumor diameter in cm) 2  + (number of lesions) 2 . The principal findings were validated using a cohort from the United States. Results R1 resection rates significantly increased as TBS increased: 4/86 (4.7%) in patients with TBS < 3, 29/171 (17.0%) in patients with TBS ≥ 3 and < 9, and 9/33 (27.3%) in patients with TBS ≥ 9 ( p  < 0.001). R0 resection was significantly superior to R1 resection in patients with TBS ≥ 5; however, this was not the case for TBS ≥ 6, as confirmed by both univariate and multivariate analyses. Furthermore, prehepatectomy chemotherapy was associated with significantly improved survival for patients with TBS ≥ 8. Analysis of the validation cohort yielded similar results. Conclusions R0 resection appeared to have a positive impact on prognosis among patients with low tumor burden; however, this was not the case for patients with high tumor burden. As such, systemic treatment, in addition to surgery, may be central to achieving satisfactory outcomes in the latter patient population.