Response to preoperative chemotherapy: impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases

Andrea Ruzzenente, Fabio Bagante, Francesca Ratti, Eliza W. Beal, Sorin Alexandrescu, Katiuscha Merath, Eleftherios A. Makris, George A. Poultsides, Georgios A. Margonis, Matthew J Weiss, Irinel Popescu, Luca Aldrighetti, Alfredo Guglielmi, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Progression of colorectal liver metastasis (CRLM) on preoperative chemotherapy has been associated with a worse prognosis compared with patients who have responsive disease. Defining response can be challenging as traditional criteria largely assess only tumor size. Methods: Patients who underwent hepatectomy between 2010 and 2017 were identified using a multi-centric database. This study aimed to define the impact of preoperative chemotherapy response relative to initial tumor burden score (TBS) and determine impact of clinico-pathological variables on overall survival (OS). Results: Among 784 patients who received preoperative chemotherapy, the regimen was oxaliplatin- (66%) or irinotecan-based (34%). Among patients with a TBS<6 at diagnosis, genetic status was the most important prognostic variable. Patients with a TBS<6, 5-year OS was 55%, 35%, and 0% for patients with KRAS/NRAS/BRAF wild-type, KRAS/NRAS, and BRAF mutations, respectively. Among patients who presented with CRLM with a TBS≥6, only Δ-TBS was prognostically important and patients with a Δ-TBS ≥ −10% had a 5-year OS of 27% compared with 49% for patients with a Δ-TBS < −10%. Conclusions: Prognostic stratification of patients with CRLM receiving preoperative chemotherapy should be multi-faceted and include consideration of initial tumor burden, change in tumor burden due to chemotherapy, and tumor genetic status.

Original languageEnglish (US)
JournalHPB
DOIs
StatePublished - Jan 1 2019

Fingerprint

Tumor Burden
Neoplasm Metastasis
Drug Therapy
Liver
Neoplasms
oxaliplatin
irinotecan
Survival
Hepatectomy
Databases
Mutation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Response to preoperative chemotherapy : impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases. / Ruzzenente, Andrea; Bagante, Fabio; Ratti, Francesca; Beal, Eliza W.; Alexandrescu, Sorin; Merath, Katiuscha; Makris, Eleftherios A.; Poultsides, George A.; Margonis, Georgios A.; Weiss, Matthew J; Popescu, Irinel; Aldrighetti, Luca; Guglielmi, Alfredo; Pawlik, Timothy M.

In: HPB, 01.01.2019.

Research output: Contribution to journalArticle

Ruzzenente, A, Bagante, F, Ratti, F, Beal, EW, Alexandrescu, S, Merath, K, Makris, EA, Poultsides, GA, Margonis, GA, Weiss, MJ, Popescu, I, Aldrighetti, L, Guglielmi, A & Pawlik, TM 2019, 'Response to preoperative chemotherapy: impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases', HPB. https://doi.org/10.1016/j.hpb.2019.01.014
Ruzzenente, Andrea ; Bagante, Fabio ; Ratti, Francesca ; Beal, Eliza W. ; Alexandrescu, Sorin ; Merath, Katiuscha ; Makris, Eleftherios A. ; Poultsides, George A. ; Margonis, Georgios A. ; Weiss, Matthew J ; Popescu, Irinel ; Aldrighetti, Luca ; Guglielmi, Alfredo ; Pawlik, Timothy M. / Response to preoperative chemotherapy : impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases. In: HPB. 2019.
@article{07a5c362fd7d4df08eadbdbd4a295502,
title = "Response to preoperative chemotherapy: impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases",
abstract = "Background: Progression of colorectal liver metastasis (CRLM) on preoperative chemotherapy has been associated with a worse prognosis compared with patients who have responsive disease. Defining response can be challenging as traditional criteria largely assess only tumor size. Methods: Patients who underwent hepatectomy between 2010 and 2017 were identified using a multi-centric database. This study aimed to define the impact of preoperative chemotherapy response relative to initial tumor burden score (TBS) and determine impact of clinico-pathological variables on overall survival (OS). Results: Among 784 patients who received preoperative chemotherapy, the regimen was oxaliplatin- (66{\%}) or irinotecan-based (34{\%}). Among patients with a TBS<6 at diagnosis, genetic status was the most important prognostic variable. Patients with a TBS<6, 5-year OS was 55{\%}, 35{\%}, and 0{\%} for patients with KRAS/NRAS/BRAF wild-type, KRAS/NRAS, and BRAF mutations, respectively. Among patients who presented with CRLM with a TBS≥6, only Δ-TBS was prognostically important and patients with a Δ-TBS ≥ −10{\%} had a 5-year OS of 27{\%} compared with 49{\%} for patients with a Δ-TBS < −10{\%}. Conclusions: Prognostic stratification of patients with CRLM receiving preoperative chemotherapy should be multi-faceted and include consideration of initial tumor burden, change in tumor burden due to chemotherapy, and tumor genetic status.",
author = "Andrea Ruzzenente and Fabio Bagante and Francesca Ratti and Beal, {Eliza W.} and Sorin Alexandrescu and Katiuscha Merath and Makris, {Eleftherios A.} and Poultsides, {George A.} and Margonis, {Georgios A.} and Weiss, {Matthew J} and Irinel Popescu and Luca Aldrighetti and Alfredo Guglielmi and Pawlik, {Timothy M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.hpb.2019.01.014",
language = "English (US)",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Response to preoperative chemotherapy

T2 - impact of change in total burden score and mutational tumor status on prognosis of patients undergoing resection for colorectal liver metastases

AU - Ruzzenente, Andrea

AU - Bagante, Fabio

AU - Ratti, Francesca

AU - Beal, Eliza W.

AU - Alexandrescu, Sorin

AU - Merath, Katiuscha

AU - Makris, Eleftherios A.

AU - Poultsides, George A.

AU - Margonis, Georgios A.

AU - Weiss, Matthew J

AU - Popescu, Irinel

AU - Aldrighetti, Luca

AU - Guglielmi, Alfredo

AU - Pawlik, Timothy M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Progression of colorectal liver metastasis (CRLM) on preoperative chemotherapy has been associated with a worse prognosis compared with patients who have responsive disease. Defining response can be challenging as traditional criteria largely assess only tumor size. Methods: Patients who underwent hepatectomy between 2010 and 2017 were identified using a multi-centric database. This study aimed to define the impact of preoperative chemotherapy response relative to initial tumor burden score (TBS) and determine impact of clinico-pathological variables on overall survival (OS). Results: Among 784 patients who received preoperative chemotherapy, the regimen was oxaliplatin- (66%) or irinotecan-based (34%). Among patients with a TBS<6 at diagnosis, genetic status was the most important prognostic variable. Patients with a TBS<6, 5-year OS was 55%, 35%, and 0% for patients with KRAS/NRAS/BRAF wild-type, KRAS/NRAS, and BRAF mutations, respectively. Among patients who presented with CRLM with a TBS≥6, only Δ-TBS was prognostically important and patients with a Δ-TBS ≥ −10% had a 5-year OS of 27% compared with 49% for patients with a Δ-TBS < −10%. Conclusions: Prognostic stratification of patients with CRLM receiving preoperative chemotherapy should be multi-faceted and include consideration of initial tumor burden, change in tumor burden due to chemotherapy, and tumor genetic status.

AB - Background: Progression of colorectal liver metastasis (CRLM) on preoperative chemotherapy has been associated with a worse prognosis compared with patients who have responsive disease. Defining response can be challenging as traditional criteria largely assess only tumor size. Methods: Patients who underwent hepatectomy between 2010 and 2017 were identified using a multi-centric database. This study aimed to define the impact of preoperative chemotherapy response relative to initial tumor burden score (TBS) and determine impact of clinico-pathological variables on overall survival (OS). Results: Among 784 patients who received preoperative chemotherapy, the regimen was oxaliplatin- (66%) or irinotecan-based (34%). Among patients with a TBS<6 at diagnosis, genetic status was the most important prognostic variable. Patients with a TBS<6, 5-year OS was 55%, 35%, and 0% for patients with KRAS/NRAS/BRAF wild-type, KRAS/NRAS, and BRAF mutations, respectively. Among patients who presented with CRLM with a TBS≥6, only Δ-TBS was prognostically important and patients with a Δ-TBS ≥ −10% had a 5-year OS of 27% compared with 49% for patients with a Δ-TBS < −10%. Conclusions: Prognostic stratification of patients with CRLM receiving preoperative chemotherapy should be multi-faceted and include consideration of initial tumor burden, change in tumor burden due to chemotherapy, and tumor genetic status.

UR - http://www.scopus.com/inward/record.url?scp=85061671667&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061671667&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2019.01.014

DO - 10.1016/j.hpb.2019.01.014

M3 - Article

C2 - 30792047

AN - SCOPUS:85061671667

JO - HPB

JF - HPB

SN - 1365-182X

ER -