title: Impact of preoperative and postoperative FOLFOX chemotherapies in patients with resectable colorectal liver metastasis.
abstract: OBJECTIVE
  Whether the survival benefit of perioperative FOLFOX in patients with liver metastases of colorectal cancer (LMCRC) is provided by preoperative chemotherapy (CT), postoperative CT, or both remains unclear. This study aimed to evaluate, in patients with resectable LMCRC, the survival impact of preoperative and postoperative separately.
  
  
  METHODS
  Between 2000 and 2010, the 179 patients (126 men, age 61 ± 11 years) with initially resectable LMCRC, who underwent liver resection (LR) and were offered pre- and/or postoperative FOLFOX were included. Twenty-four (13%) patients did not receive CT, 27(15%) patients received only preoperative CT, 71 (40%) patients received only postoperative CT, and 57 (32%) patients received both pre- and postoperative CT.
  
  
  RESULTS
  Operative morbidity and mortality rates were 19 and 0.6%, respectively. At 1, 3, and 5 years, OS and DFS rates were 97, 66, 46 and 60, 32, and 24%, respectively. Postoperative FOLFOX was an independent predictor of increased OS (HR = 0.55 [95% CI, 0.35-0.87] p = 0.01) and DFS (HR = 0.54 [0.36-0.82] p = 0.0017), whereas the synchronous onset of the metastasis and the presence of radiographically occult liver metastases were independent predictors of poorer OS. Alternatively, preoperative FOLFOX had no significant influence on OS (HR = 0.96 [0.57-1.60] p = 0.83) or DFS (HR = 1.05 [0.66-1.66] p = 0.87).
  
  
  CONCLUSIONS
  The survival benefit of FOLFOX in patients with resectable LMCRC may be provided by postoperative rather than preoperative administration.
authors.affiliation: Department of Digestive Surgery, AP-HP Hôpital Saint Antoine, 184, rue du Faubourg Saint Antoine, Paris, 75012, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Faron
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
authors.forename: Hadrien
authors.initials: H
authors.lastname: Tranchard
authors.forename: Pierre
authors.initials: P
authors.lastname: Balladur
authors.forename: Aimery
authors.initials: A
authors.lastname: de Gramont
authors.forename: Pauline
authors.initials: P
authors.lastname: Afchain
authors.forename: Thierry
authors.initials: T
authors.lastname: Andre
authors.forename: François
authors.initials: F
authors.lastname: Paye
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005188:False Negative Reactions; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011182:Postoperative Care; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil