Prognostic Impact of Adjuvant Chemotherapy after Hepatic Resection for Synchronous and Early Metachronous Colorectal Liver Metastases

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Background: Although the usefulness of adjuvant chemotherapy has been established in the treatment for stages II/III colorectal cancer, its prognostic advantage for colorectal liver metastases (CLM) remains controversial. Methods: Two hundred and nine patients who underwent curative resection for CLM were reviewed. The potential advantage of adjuvant chemotherapy was investigated in 3 groups stratified by disease-free interval (DFI): synchronous CLM (S-CLM), early metachronous CLM (EM-CLM, DFI ≤1 year), and late metachronous CLM (LM-CLM, DFI >1 year). Results: Of the 105 patients who underwent adjuvant chemotherapy after surgery, 47 received uracil-tegafur and leucovorin (UFT/LV) while 58 received the oxaliplatin-based regimen. Five-year recurrence-free survival (RFS) rates in patients with/without adjuvant chemotherapy were 32.8/11.2% in S-CLM (p = 0.002), 43.7/15.2% in EM-CLM (p = 0.002), 44.1/29.6% in LM-CLM (p = 0.163), respectively. Five-year overall survival (OS) rates were 77.9/44.5% in S-CLM (p = 0.021), 81.5/39.5% in EM-CLM (p = 0.015), 76.1/65.4% in LM-CLM (p = 0.411), respectively. Multivariate analyses in S-CLM and EM-CLM indicated that adjuvant chemotherapy is correlated with better RFS and OS irrespective of the regimens, while the incidence of severe adverse event was significantly different between UFT/LV and oxaliplatin (6.8 vs. 50.9%, p < 0.0001). Conclusion: Adjuvant chemotherapy might improve the clinical outcomes in S-CLM and EM-CLM. UFT/LV might be a choice for CLM in adjuvant settings in selected patients.

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