title: The use of neo-adjuvant chemotherapy in patients with resectable colorectal liver metastases: Clinical risk score as possible discriminator.
abstract: OBJECTIVE
  The combination of surgery and chemotherapy (CTx) is increasingly accepted as an effective treatment for patients with colorectal liver metastases (CRLM). However, controversy exists whether all patients with resectable CRLM benefit from perioperative CTx. We investigated the impact on overall survival (OS) by neo-adjuvant CTx in patients with resectable CRLM, stratified by the clinical risk score (CRS) described by Fong et al.
  
  
  METHODS
  Patients who underwent surgery for CRLM between January 2000 and December 2009 were included. We compared OS of patients with and without neo-adjuvant CTx stratified by the CRS. The CRS includes five prognosticators and defines two risk groups: low CRS (0-2) and high CRS (3-5).
  
  
  RESULTS
  363 patients (64% male) were included, median age 63 years (IQR 57-70). Prior to resection, 219 patients had a low CRS (neo-adjuvant CTx: N = 65) and 144 patients had a high CRS (neo-adjuvant CTx: N = 88). Median follow-up was 47 months (IQR 25-82). In the low CRS group, there was no significant difference in median OS between patients with and without CTx (65 months (95% CI 39-91) vs. 54 months (95% CI 44-64), P = 0.31). In the high CRS group, there was a significant difference in OS between patients with and without CTx (46 months (95% CI 24-68) vs. 33 month (95% CI 29-37), P = 0.004).
  
  
  CONCLUSIONS
  In our series, patients with a high CRS benefit from neo-adjuvant CTx. In patients with a low risk profile, neo-adjuvant CTx might not be beneficial.
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Ayez
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
authors.forename: E P
authors.initials: EP
authors.lastname: van der Stok
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands. Electronic address: d.grunhagen@erasmusmc.nl.
authors.forename: D J
authors.initials: DJ
authors.lastname: Grünhagen
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Rothbarth
authors.affiliation: Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van Meerten
authors.affiliation: Cancer Institute, Gustave Roussy Cancer Campus, Grand Paris, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Eggermont
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D000077146:Irinotecan; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011237:Predictive Value of Tests; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Chemotherapy; Clinical risk score; Liver metastases; Surgery