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Improved Survival After Resection of Colorectal Liver Metastases

Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX

To the Editor:

We read with interest the study from Liersch et al¹ in the September 30, 2005, issue of the Journal of Clinical Oncology. The authors are to be commended for their results (51% 5-year survival) in this small cohort of patients with colorectal liver metastases (CLM) treated by hepatic resection with long-term follow-up (median, 64 months). Although they attribute their results to treatment with adjuvant radioimmunotherapy (RAIT) with iodine-131 labetuzumab, their results must be reassessed in the setting of recent outcome data in five larger series (including a multicenter trial) that reveal results comparable to or better than those reported in their study without the use of RAIT.

Despite expanding indications for resection of colorectal liver metastases, several studies have shown marked improvement in survival compared with historical series. Figueras et al² revealed 53% 5-year overall survival after resection of 99 patients treated with adjuvant systemic chemotherapy (including 14% with resected extrahepatic disease). Subsequently, Choti et al³ compared survival after hepatic resection for CLM during two time periods, 1984 to 1992 versus 1993 to 1999, and showed a shift in overall survival from 31% in the early period to 58% in the later period. Two subsequent large, single-institution studies including 190 patients⁴ and 100 patients,⁵ and a large, multi-institutional study of 557 patients⁶ who underwent hepatic resection, all without RAIT, revealed the same 58% 5-year overall survival.

We recently reported 71% 5-year overall and 50% 5-year disease-free survival after hepatic resection in 150 patients with solitary CLM, which further emphasizes the improving outcome for hepatic resection of CLM.⁷ This survival rate is nearly double the rate reported in series from the early 1990s,⁸ when the outcome for resection of solitary versus multiple tumors was reported to be similar, and underscores the improving outcome for resection among all treated patients with CLM.

Given the aforementioned results in five larger series, the Liersch et al's conclusion that RAIT improves survival after hepatic resection comes into question. Careful scrutiny of the population studied shows that a fairly average mix of patients (six of 23 patients had solitary tumors; overall range, one to four tumors per patient except for one patient with six tumors and four patients with an unknown number of tumors). This is similar to populations studied in the larger series (in which 38% to 55% of patients had multiple tumors). Finally, the disease-free interval in the Liersch et al study is not different from the interval reported in the five larger series without RAIT.

Survival after resection for CLM is improving. Advances in preoperative and intraoperative imaging, low-mortality extended hepatic resection, techniques for safe resection of bilateral lesions, and better chemotherapy likely contribute to improving outcomes, despite expanding indications for hepatic resection for CLM. Real advances in overall treatment for patients with metastatic cancer will require continued innovative multidisciplinary therapy and careful patient-by-patient selection for aggressive treatment.

Authors' Disclosures of Potential Conflicts of Interest

Although all authors completed the disclosure declaration, the following authors or their immediate family members indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Authors Employment Leadership Consultant Stock Honoraria Research Funds Testimony Other Jean-Nicolas Vauthey sanofi-aventis (A)

Dollar Amount Codes (A) < $10,000 (B) $10,000-99,999 (C) $100,000 (N/R) Not Required

REFERENCES

1. Liersch T, Meller J, Kulle B, et al: Phase II trial of carcinoembryonic antigen radioimmunotherapy with 131I-labetuzumab after salvage resection of colorectal metastases in the liver: Five-year safety and efficacy results. J Clin Oncol 23:6763-6770, 2005[Abstract/Free Full Text]

2. Figueras J, Valls C, Rafecas A, et al: Resection rate and effect of postoperative chemotherapy on survival after surgery for colorectal liver metastases. Br J Surg 88:980-985, 2001[CrossRef][Medline]

3. Choti MA, Sitzmann JV, Tiburi MF, et al: Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759-766, 2002[CrossRef][Medline]

4. Abdalla EK, Vauthey JN, Ellis LM, et al: Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818-825, 2004[CrossRef][Medline]

5. Fernandez FG, Drebin JA, Linehan DC, et al: Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 240:438-447, 2004[CrossRef][Medline]

6. Pawlik TM, Scoggins CR, Zorzi D, et al: Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715-724, 2005[CrossRef][Medline]

7. Aloia TA, Vauthey JN, Loyer EM, et al: Solitary colorectal liver metastasis: Resection determines outcome. Arch Surg 141:460-467, 2006

8. Scheele J, Stangl R, Altendorf-Hofmann A, et al: Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110:13-29, 1991[Medline]

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Related Reply

• In Reply:
  Torsten Liersch, Heinz Becker, and David M. Goldenberg
  JCO 2006 24: 2680-2681 [Full Text]

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