title: Management of liver metastases in colorectal cancer patients: A retrospective case-control study of systemic therapy versus liver resection.
abstract: To evaluate and compare the overall survival (OS) in case-matched patient groups treated either with systemic therapy or surgery for colorectal liver metastases (CRLM).
  
  
  
  Patients with CRLM, without extra-hepatic disease, treated with chemotherapy with or without targeted therapy in two phase III studies (n = 480) were selected and case-matched to patients who underwent liver resection (n = 632). Matching criteria were sex, age, established prognostic factors for survival (clinical risk score). Available computed tomography (CT)-scans of patients treated with systemic therapies were reviewed by three independent liver surgeons for resectability. Survival was compared between patients with resectable CRLM (based on CT-scan review) who were treated with systemic therapy versus patients who underwent liver resection.
  
  
  
  A total of 96 patients treated with systemic therapy were included. Pre-treatment CT-scans of the liver were available for review in 56 of the systemically treated patients, and metastases were unanimously considered resectable in 36 patients (64.3%) (complex resectable: n = 25; 69%). These 36 patients were case-matched with 36 patients who underwent liver resection (wedge resection or segmentectomy: n = 26; 72%). Median OS in the patient group treated with systemic therapy was 26.5 months (range 0-81 months), which was significantly lower than that in case-matched patients who underwent liver resection (median OS 56 months; range 6-116) (p = 0.027).
  
  
  
  In this case-matched control study, surgery provided superior OS rates compared to systemic therapy for CRLM. Resection of CRLM should always be considered, preferably in a dedicated liver centre, since not all patients that qualify for resection are identified as such.
authors.affiliation: Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: jannemarie.deridder@radboudumc.nl.
authors.forename: Jannemarie A M
authors.initials: JAM
authors.lastname: de Ridder
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: van der Stok
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Leonie J
authors.initials: LJ
authors.lastname: Mekenkamp
authors.affiliation: Department of Surgery, Slingeland Hospital, Doetinchem, The Netherlands.
authors.forename: Bastiaan
authors.initials: B
authors.lastname: Wiering
authors.affiliation: Department of Medical Oncology, University Medical Center Utrecht, The Netherlands.
authors.forename: Miriam
authors.initials: M
authors.lastname: Koopman
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Cornelis J A
authors.initials: CJA
authors.lastname: Punt
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Johannes H
authors.initials: JH
authors.lastname: de Wilt
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D000069287:Capecitabine / Q000008:administration & dosage; D016022:Case-Control Studies; D000068818:Cetuximab / Q000008:administration & dosage; D003110:Colonic Neoplasms; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012004:Rectal Neoplasms; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D000069287:Capecitabine; D000068818:Cetuximab
keywords: Colorectal liver metastases; Liver resection; Surgical treatment; Survival; Systemic therapy; Treatment