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Article Open Access

Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis

  • Authors:
    • Koichi Suzuki
    • Yuta Muto
    • Kosuke Ichida
    • Taro Fukui
    • Yuji Takayama
    • Nao Kakizawa
    • Takaharu Kato
    • Fumi Hasegawa
    • Fumiaki Watanabe
    • Yuji Kaneda
    • Rina Kikukawa
    • Masaaki Saito
    • Shingo Tsujinaka
    • Kazushige Futsuhara
    • Osamu Takata
    • Hiroshi Noda
    • Yasuyuki Miyakura
    • Hirokazu Kiyozaki
    • Fumio Konishi
    • Toshiki Rikiyama
  • View Affiliations / Copyright

    Affiliations: Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama 330‑8503, Japan, Department of Surgery, Nerima‑Hikarigaoka Hospital, Tokyo 179‑0072, Japan
    Copyright: © Suzuki et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 1491-1499
    |
    Published online on: June 7, 2017
       https://doi.org/10.3892/ol.2017.6338
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Abstract

Morphological response is considered an improved surrogate to the Response Evaluation Criteria in Solid Tumors (RECIST) model with regard to predicting the prognosis for patients with colorectal liver metastases. However, its use as a decision-making tool for surgical intervention has not been examined. The present study assessed the morphological response in 50 patients who underwent chemotherapy with or without bevacizumab for initially un‑resectable colorectal liver metastases. Changes in tumor morphology between heterogeneous with uncertain borders and homogeneous with clear borders were defined as an optimal response (OR). Patients were also assessed as having an incomplete response (IR), and an absence of marked changes was assessed as no response (NR). No significant difference was observed in progression‑free survival (PFS) between complete response/partial response (CR/PR) and stable disease/progressive disease (SD/PD), according to RECIST. By contrast, PFS for OR/IR patients was significantly improved compared with that for NR patients (13.2 vs. 8.7 months; P=0.0426). Exclusion of PD enhanced the difference in PFS between OR/IR and NR patients (15.1 vs. 9.3 months; P<0.0001), whereas no difference was observed between CR/PR and SD. The rate of OR and IR in patients treated with bevacizumab was 47.4% (9/19), but only 19.4% (6/31) for patients that were not administered bevacizumab. Comparison of the survival curves between OR/IR and NR patients revealed similar survival rates at 6 months after chemotherapy, but the groups exhibited different survival rates subsequent to this period of time. Patients showing OR/IR within 6 months appeared to be oncologically stable and could be considered as candidates for surgical intervention, including rescue liver resection. Comparing the pathological and morphological features of the tumor with representative optimal response, living tumor cells were revealed to be distributed within the area of vascular reconstruction induced by bevacizumab, resulting in a predictive value for prognosis in the patients treated with bevacizumab. The present findings provided the evidence for physicians to consider patients with previously un-resectable metastatic colorectal cancer as candidates for surgical treatment. Morphological response is a useful decision‑making tool for evaluating these patients for rescue liver resection following chemotherapy.
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Copy and paste a formatted citation
Spandidos Publications style
Suzuki K, Muto Y, Ichida K, Fukui T, Takayama Y, Kakizawa N, Kato T, Hasegawa F, Watanabe F, Kaneda Y, Kaneda Y, et al: Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis. Oncol Lett 14: 1491-1499, 2017.
APA
Suzuki, K., Muto, Y., Ichida, K., Fukui, T., Takayama, Y., Kakizawa, N. ... Rikiyama, T. (2017). Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis. Oncology Letters, 14, 1491-1499. https://doi.org/10.3892/ol.2017.6338
MLA
Suzuki, K., Muto, Y., Ichida, K., Fukui, T., Takayama, Y., Kakizawa, N., Kato, T., Hasegawa, F., Watanabe, F., Kaneda, Y., Kikukawa, R., Saito, M., Tsujinaka, S., Futsuhara, K., Takata, O., Noda, H., Miyakura, Y., Kiyozaki, H., Konishi, F., Rikiyama, T."Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis". Oncology Letters 14.2 (2017): 1491-1499.
Chicago
Suzuki, K., Muto, Y., Ichida, K., Fukui, T., Takayama, Y., Kakizawa, N., Kato, T., Hasegawa, F., Watanabe, F., Kaneda, Y., Kikukawa, R., Saito, M., Tsujinaka, S., Futsuhara, K., Takata, O., Noda, H., Miyakura, Y., Kiyozaki, H., Konishi, F., Rikiyama, T."Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis". Oncology Letters 14, no. 2 (2017): 1491-1499. https://doi.org/10.3892/ol.2017.6338
Copy and paste a formatted citation
x
Spandidos Publications style
Suzuki K, Muto Y, Ichida K, Fukui T, Takayama Y, Kakizawa N, Kato T, Hasegawa F, Watanabe F, Kaneda Y, Kaneda Y, et al: Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis. Oncol Lett 14: 1491-1499, 2017.
APA
Suzuki, K., Muto, Y., Ichida, K., Fukui, T., Takayama, Y., Kakizawa, N. ... Rikiyama, T. (2017). Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis. Oncology Letters, 14, 1491-1499. https://doi.org/10.3892/ol.2017.6338
MLA
Suzuki, K., Muto, Y., Ichida, K., Fukui, T., Takayama, Y., Kakizawa, N., Kato, T., Hasegawa, F., Watanabe, F., Kaneda, Y., Kikukawa, R., Saito, M., Tsujinaka, S., Futsuhara, K., Takata, O., Noda, H., Miyakura, Y., Kiyozaki, H., Konishi, F., Rikiyama, T."Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis". Oncology Letters 14.2 (2017): 1491-1499.
Chicago
Suzuki, K., Muto, Y., Ichida, K., Fukui, T., Takayama, Y., Kakizawa, N., Kato, T., Hasegawa, F., Watanabe, F., Kaneda, Y., Kikukawa, R., Saito, M., Tsujinaka, S., Futsuhara, K., Takata, O., Noda, H., Miyakura, Y., Kiyozaki, H., Konishi, F., Rikiyama, T."Morphological response contributes to patient selection for rescue liver resection in chemotherapy patients with initially un-resectable colorectal liver metastasis". Oncology Letters 14, no. 2 (2017): 1491-1499. https://doi.org/10.3892/ol.2017.6338
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