Survival of patients with colorectal liver metastases treated with and without preoperative chemotherapy: Nationwide propensity score-matched study

Michelle R de Graaff; Joost M Klaase; Ronald M van Dam; Koert F D Kuhlmann; Geert Kazemier; Rutger-Jan Swijnenburg; Arthur K E Elfrink; Cees Verhoef; J Sven Mieog; Peter B van den Boezem; Paul Gobardhan; Arjen M Rijken; Daan J Lips; Wouter G K Leclercq; Hendrik A Marsman; Peter van Duijvendijk; Joost A B van der Hoeven; Maarten Vermaas; Marcel den Dulk; Dirk J Grünhagen; Niels F M Kok; for Dutch Hepato Biliary Audit Group, Collaborators

doi:10.1016/j.ejso.2023.05.007

Survival of patients with colorectal liver metastases treated with and without preoperative chemotherapy: Nationwide propensity score-matched study

Eur J Surg Oncol. 2023 Sep;49(9):106932. doi: 10.1016/j.ejso.2023.05.007. Epub 2023 May 15.

Authors

Michelle R de Graaff¹, Joost M Klaase², Ronald M van Dam³, Koert F D Kuhlmann⁴, Geert Kazemier⁵, Rutger-Jan Swijnenburg⁵, Arthur K E Elfrink⁵, Cees Verhoef⁶, J Sven Mieog⁷, Peter B van den Boezem⁸, Paul Gobardhan⁹, Arjen M Rijken⁹, Daan J Lips¹⁰, Wouter G K Leclercq¹¹, Hendrik A Marsman¹², Peter van Duijvendijk¹³, Joost A B van der Hoeven¹⁴, Maarten Vermaas¹⁵, Marcel den Dulk³, Dirk J Grünhagen⁶, Niels F M Kok⁴; for Dutch Hepato Biliary Audit Group, Collaborators

Collaborators

for Dutch Hepato Biliary Audit Group, Collaborators:
Carlijn I Buis², Jeroen Hagendoorn¹⁶, Wouter J M Derksen¹⁶, Hans Torrenga¹⁷, Eric Manusama¹⁸, N Tjarda van Heek¹⁹, Steven J Oosterling²⁰, Koop Bosscha²¹, Andries E Braat⁷, Frederik J H Hoogwater², Esther C J Consten²², Christiaan van der Leij³, Mark C Burgmans⁶, Mike S L Liem¹⁰, Eric J Th Belt¹⁴, Gijs A Patijn¹³

Affiliations

¹ Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands. Electronic address: m.r.de.graaff@umcg.nl.
² Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
³ Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
⁴ Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands.
⁵ Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁶ Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
⁷ Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
⁸ Department of Surgery, Radboud Medical Centre, Nijmegen, the Netherlands.
⁹ Department of Surgery, Amphia Medical Centre, Breda, the Netherlands.
¹⁰ Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands.
¹¹ Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands.
¹² Department of Surgery, OLVG, Amsterdam, the Netherlands.
¹³ Department of Surgery, Isala, Zwolle, the Netherlands.
¹⁴ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
¹⁵ Department of Surgery, Ijsselland Hospital, Capelle aan de Ijssel, the Netherlands.
¹⁶ Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
¹⁷ Department of Surgery, Deventer ziekenhuis, Deventer, the Netherlands.
¹⁸ Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
¹⁹ Department of Surgery, Gelderse Vallei, Ede, the Netherlands.
²⁰ Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.
²¹ Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.
²² Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands Department of Surgery, University, the Netherlands.

PMID: 37302900
DOI: 10.1016/j.ejso.2023.05.007

Abstract

Introduction: Routine treatment with preoperative systemic chemotherapy (CTx) in patients with colorectal liver metastases (CRLM) remains controversial due to lack of consistent evidence demonstrating associated survival benefits. This study aimed to determine the effect of preoperative CTx on overall survival (OS) compared to surgery alone and to assess hospital and oncological network variation in 5-year OS.

Methods: This was a population-based study of all patients who underwent liver resection for CRLM between 2014 and 2017 in the Netherlands. After 1:1 propensity score matching (PSM), OS was compared between patients treated with and without preoperative CTx. Hospital and oncological network variation in 5-year OS corrected for case-mix factors was calculated using an observed/expected ratio.

Results: Of 2820 patients included, 852 (30.2%) and 1968 (69.8%) patients were treated with preoperative CTx and surgery alone, respectively. After PSM, 537 patients remained in each group, median number of CRLM; 3 [IQR 2-4], median size of CRLM; 28 mm [IQR 18-44], synchronous CLRM (71.1%). Median follow-up was 80.8 months. Five-year OS rates after PSM for patients treated with and without preoperative chemotherapy were 40.2% versus 38.3% (log-rank P = 0.734). After stratification for low, medium, and high tumour burden based on the tumour burden score (TBS) OS was similar for preoperative chemotherapy vs. surgery alone (log-rank P = 0.486, P = 0.914, and P = 0.744, respectively). After correction for non-modifiable patient and tumour characteristics, no relevant hospital or oncological network variation in five-year OS was observed.

Conclusion: In patients eligible for surgical resection, preoperative chemotherapy does not provide an overall survival benefit compared to surgery alone.

Keywords: Chemotherapy; Colorectal liver metastases; Liver surgery; Overall survival; Practice variation.

MeSH terms

Colorectal Neoplasms* / pathology
Hepatectomy
Humans
Liver Neoplasms* / drug therapy
Liver Neoplasms* / surgery
Propensity Score
Retrospective Studies