Claire Goumard

Loss of muscle mass during preoperative chemotherapy as a prognosticator for poor survival in patients with colorectal liver metastases

Background: The survival impact of specific body composition changes during preoperative chemotherapy in patients with colorectal liver metastases undergoing curative‐intent surgery remains unclear. This study aimed to determine the impact of changes in body weight and muscle mass during preoperative chemotherapy on survival after hepatectomy in patients with colorectal liver metastases. Methods: Consecutive patients with colorectal liver metastases undergoing preoperative chemotherapy and curative hepatectomy during 2009–2013 were retrospectively analyzed. Recurrence‐free and overall survival were examined according to body compositions, including muscle mass, as measured by skeletal muscle index (area of muscle [cm2]/square of height [m2]), and body weight before and after preoperative chemotherapy. Results: The median follow‐up duration in overall 169 patients was 47 months. Skeletal muscle index and body weight changed significantly during chemotherapy (skeletal muscle index: –0.52 cm2/m2, P = .03; body weight: +1.1 kg, P = .002). Patients with major muscle mass loss (≥7%) had significantly shorter median RFS than patients with no or minor muscle mass loss (<7%) (9.6 months vs 15.9 months; P = .02). Although major muscle mass loss was associated with poor outcome, skeletal muscle index before or after preoperative chemotherapy was not associated with recurrence‐free or overall survival. On multivariate analysis, major muscle mass loss was independently associated with poorer recurrence‐free survival (hazard ratio, 1.76; P = .045). Conclusion: Major loss of muscle mass but not body weight loss during preoperative chemotherapy is significantly associated with poor recurrence‐free survival after hepatectomy in patients with colorectal liver metastases. The mechanisms mediating this association may inform future trials on maintaining muscle mass with dedicated nutrition and exercise programs to improve outcomes.

Loss of muscle mass during preoperative chemotherapy predicts worse recurrence-free survival in patients with resectable colorectal liver metastases

MTA and 9.7% in the RFA group (p = 0.85). There was no mortality. Median hospital stay was 1 day for both groups. For the RFA vs MTA groups, local recurrence (LR) rate per lesion was 20.3% and 8.5%, respectively (p = 0.01). On Cox Proportion Hazards model, ablation modality was an independent predictor of LR following risk adjustment. Conclusion: To our knowledge, this is the first comparison of RFA and MTA in the treatment of CRLM. Our results demonstrates MTA achieves better local tumor control with shorter operative and ablation time.

Minimally invasive management of the entire treatment sequence in patients with stage IV colorectal cancer: a propensity-score weighting analysis

BACKGROUND In patients with stage IV colorectal cancer (CRC), minimally invasive surgery (MIS) may offer optimal oncologic outcome with low morbidity. However, the relative benefit of MIS compared to open surgery in patients requiring multistage resections has not been evaluated. METHODS Patients who underwent totally minimally invasive (TMI) or totally open (TO) resections of CRC primary and liver metastases (CLM) in 2009-2016 were analyzed. Inverse probability of weighted adjustment by propensity score was performed before analyzing risk factors for complications and survival. RESULTS The study included 43 TMI and 121 TO patients. Before and after adjustment, TMI patients had significantly less cumulated postoperative complications (41% vs. 59%, p = 0.001), blood loss (median 100 vs. 200 ml, p = 0.001) and shorter length of hospital stay (median 4.5 vs. 6.0 days, p < 0.001). Multivariate analysis identified TO approach vs. MIS (OR = 2.4, p < 0.001), major liver resection (OR = 4.4, p < 0.001), and multiple CLM (OR = 2.3, p = 0.001) as independent risk factors for complications. 5-year overall survival was comparable (81% vs 68%, p = 0.59). CONCLUSION In patients with CRC undergoing multistage surgical treatment, MIS resection contributes to optimal perioperative outcomes without compromise in oncologic outcomes.

Prognostic impact of perihepatic lymph node metastases in patients with resectable colorectal liver metastases

Although perihepatic lymph node metastases (PLNMs) are known to be a poor prognosticator for patients with colorectal liver metastases (CRLMs), optimal management remains unclear. This study aimed to determine the risk factors for PLNMs, and the survival impact of their number and location in patients with resectable CRLMs.

ASO Author Reflections: Non-GIST Sarcoma Liver Metastasis: How to Use the Past and Present to Predict the Future

Non-gastrointestinal stromal tumor sarcomas (NGSs) are rare and heterogeneous mesenchymal tumors with potential to metastasize to the liver. The therapeutic impact and prognostic value of response to preoperative chemotherapy in these patients are incompletely understood. In this context, the RECIST 1.1 criteria have been widely used for radiologic response assessment, but some studies have indicated that Choi criteria may better predict survival in patients with NGS undergoing chemotherapy., 3 Prior studies analyzing the impact of metastasectomy of NGS have been limited by small cohorts and lack of stratification by subtype. Considering the rarity of resectable liver metastases from NGS, finding prognosticators that may help providers predict a therapeutic benefit from metastasectomy has been very challenging, but important. Therefore, the authors’ aim was to analyze a large cohort of patients who underwent resection of NGSLM (1) to elucidate the optimal way to assess response to preoperative chemotherapy and (2) to quantify a correlation between tumor response and survival. PRESENT