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Pathologic Response to Preoperative Chemotherapy in Colorectal Liver Metastases: Fibrosis, not Necrosis, Predicts Outcome

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pathologic response to preoperative chemotherapy for colorectal liver metastases (CLM) is associated with survival after hepatectomy. Histologically, dominant response patterns include fibrosis, necrosis and/or acellular mucin, but some of these changes can appear without previous chemotherapy and their individual correlation with outcome is unknown.

Methods

Pathology slides from patients who underwent CLM resection (irrespective of preoperative chemotherapy status) were rereviewed by a blinded pathologist. Pathologic response was recorded as the summation of percentage necrosis, fibrosis and acellular mucin. Associations between pathologic response, its components, preoperative chemotherapy, and survival were analyzed.

Results

Pathology slides were rereviewed in 366 patients undergoing CLM resection from 2003 to 2007. Preoperative chemotherapy was administered in 249 (68 %) patients, who, when compared to no preoperative chemotherapy patients, had higher rates of overall pathologic response (57 vs. 46 %, P < .01), fibrosis (21 vs. 12 %, P < .01) and acellular mucin (6 vs. 3 %, P = .05) but similar rates of necrosis (30 vs. 31 %, P = .30). In patients receiving preoperative chemotherapy, overall pathologic response ≥75 % (5 year, 83 vs. 47 %, P < .01) and fibrosis ≥40 % (5 year, 87 vs. 51 %, P < .01) independently correlated with disease-specific survival after hepatectomy. Preoperative hepatic artery infusion chemotherapy (P = .04) and bevacizumab (P = .05) were marginally associated with overall pathologic response and fibrosis, respectively.

Conclusions

Fibrosis is the predominant chemotherapy-related pathologic alteration driving the association of treatment response with survival after CLM resection. Necrosis in CLM is not related to chemotherapy or outcome.

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Disclosure

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Author notes

  1. George A. Poultsides MD, MS

    Present address: Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

  2. Fei Bao MD

    Present address: Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY, USA

Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    George A. Poultsides MD, MS, Elliot L. Servais MD, Ronald P. DeMatteo MD, Peter J. Allen MD, Yuman Fong MD, William R. Jarnagin MD & Michael I. D’Angelica MD

  2. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Fei Bao MD, David S. Klimstra MD & Jinru Shia MD

  3. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Tina Hernandez-Boussard PhD

  4. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Nancy E. Kemeny MD & Leonard B. Saltz MD

Authors
  1. George A. Poultsides MD, MS
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  2. Fei Bao MD
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  3. Elliot L. Servais MD
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  11. William R. Jarnagin MD
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  12. Jinru Shia MD
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  13. Michael I. D’Angelica MD
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Corresponding author

Correspondence to Jinru Shia MD.

Additional information

The first two authors contributed equally to this work.

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Poultsides, G.A., Bao, F., Servais, E.L. et al. Pathologic Response to Preoperative Chemotherapy in Colorectal Liver Metastases: Fibrosis, not Necrosis, Predicts Outcome. Ann Surg Oncol 19, 2797–2804 (2012). https://doi.org/10.1245/s10434-012-2335-1

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  • DOI: https://doi.org/10.1245/s10434-012-2335-1

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