title: Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases.
abstract: BACKGROUND
  Liver resection is the only curative treatment offering a chance of long-term survival in patients with colorectal liver metastases (CRM). Recent data indicated that liver resection in patients with tumor progression while receiving chemotherapy was associated with poor outcome. The aim of the study was to identify risk factors for poor outcome in patients with pre-operative chemotherapy of CRM.
  
  
  METHODS
  We analyzed 160 patients after liver resection for CRM with preoperative systemic. chemotherapy. Three groups of patients were identified: 44 patients (27.5%) had a tumor response, 20 (12.5%) showed stable disease, and 96 (60%) patients had tumor progression while on chemotherapy. Median follow-up was 2.4 years (range, 6 days-11.1 years). All available clinicopathologic variables possibly associated with outcome were evaluated.
  
  
  RESULTS
  Survival was 88%, 53%, and 37% at 1, 3, and 5 years. Noncurative resection, carcinoembryonic antigen levels >200 ng/ml, tumor grading, size of the largest tumor >5 cm, and number of metastases were associated with poor patient outcome. In the multivariate analysis, tumor free margin and tumor grading correlated with the outcome. Tumor progression while on chemotherapy had no influence on the long-term survival.
  
  
  CONCLUSIONS
  Liver resection offers a long-term survival benefit for patients with CRM, even when tumor growth proceeds during pre-operative chemotherapy.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany. ulf.neumann@charite.de
authors.forename: Ulf P
authors.initials: UP
authors.lastname: Neumann
authors.forename: Armin
authors.initials: A
authors.lastname: Thelen
authors.forename: Christoph
authors.initials: C
authors.lastname: Röcken
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: Hanno
authors.initials: H
authors.lastname: Riess
authors.forename: Sven
authors.initials: S
authors.lastname: Jonas
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schmeding
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Roberta
authors.initials: R
authors.lastname: Bova
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen; D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil