Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy

• DOI: 10.1002/cncr.24912
• Publication Date: 2010-01-29T21:40:26Z
• Authors: Rebecca C. Auer; Rebekah R. White; Nancy E. Kemeny; Lawrence H. Schwartz; Jinru Shia; Leslie H. Blumgart; Ronald P. DeMatteo; Yuman Fong; William R. Jarnagin; Michael I. D'Ange...
• Keywords: Male; Liver Neoplasms; Remission Induction; Middle Aged; Combined Modality Therapy; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Chemotherapy, Adjuvant; Recurrence; Antineoplastic Combined Chemotherapy Protocols; Humans; Female; Colorectal Neoplasms; Aged; Tomography, Emission-Computed

AbstractBACKGROUND:During chemotherapy, some colorectal liver metastases (LMs) disappear on serial imaging. This disappearance may represent a complete response (CR) or a reduction in the sensitivity of imaging during chemotherapy. The objective of the current study was to determine the fate of disappearing LMs (DLMs) and the factors that predict a true CR.METHODS:Between 2000 and 2003, 435 patients who were evaluated by hepatobiliary surgeons received chemotherapy before they were considered for resection. Inclusion criteria were <12 LMs before chemotherapy, at least 1 DLM on a computed tomography (CT) scan, and either surgical resection or 1 year of clinical follow‐up after the disappearance of LMs. A true CR was defined as either a pathologic CR (no tumor detected in the resection specimen) or a durable clinical CR (did not reappear on follow‐up imaging). Clinical and pathologic factors were analyzed to identify those associated with a true CR.RESULTS:During chemotherapy, 39 patients (9%) had a total of 118 DLMs on follow‐up CT scans. Sixty‐eight DLMs were resected, and 50 were followed clinically. Overall, 75 DLMs (64%) were true CRs, including 44 pathologic CRs and 31 durable clinical CRs. On multivariate analysis, the use of hepatic arterial infusion (HAI) chemotherapy (odds ratio [OR], 6.2; P = .02), the inability to observe the DLM on a magnetic resonance image (OR, 4.7; P = .005), and normalization of serum carcinoembryonic antigen levels (OR, 4.6; P = .006) were associated independently with a true CR.CONCLUSIONS:Approximately 66% of DLMs represented a true CR according to assessment by resection or radiologic follow‐up. Predictive factors may help to stratify patients who are likely to harbor residual disease. Cancer 2010. © 2010 American Cancer Society.