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Chemotherapy or Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
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2015 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 5, p. 956-960Article in journal (Refereed) Published
Abstract [en]

Objective: The primary objective was to compare overall survival (OS) in patients with colorectal cancer (CRC) with nonresectable liver-only metastases treated by liver transplantation or chemotherapy. Background: CRC is the third most common cancer worldwide. About 50% of patients will develop metastatic disease primarily to the liver and the lung. The majority of patients with liver metastases receive palliative chemotherapy, with a median OS of trial patients of about 2 years, and less than 10% are alive at 5 years. Methods: Patients with nonresectable liver-only CRC metastases underwent liver transplantation in the SECA study (n = 21). Disease-free survival (DFS) and OS of patients included in the SECA study were compared with progression-free survival (PFS) and OS in a similar cohort of CRC patients with liver-only disease included in a first-line chemotherapy study, the NORDIC VII study (n = 47). PFS/DFS and OS were estimated by the Kaplan-Meier method. Results: DFS/PFS in both groups were 8 to 10 months. However, a dramatic difference in OS was observed. The 5-year OS rate was 56% in patients undergoing liver transplantation compared with 9% in patients starting first-line chemotherapy. The reason for the large difference in OS despite similar DFS/PFS is likely different metastatic patterns at relapse/progression. Relapse in the liver transplantation group was often detected as small, slowly growing lung metastases, whereas progression of nonresectable liver metastases was observed in the chemotherapy group. Conclusions: Compared with chemotherapy, liver transplantation resulted in a marked increased OS in CRC patients with nonresectable liver-only metastases.

Place, publisher, year, edition, pages
2015. Vol. 261, no 5, p. 956-960
Keywords [en]
chemotherapy, colorectal cancer, liver metastases, liver transplantation, overall survival
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Surgery
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URN: urn:nbn:se:uu:diva-252158DOI: 10.1097/SLA.0000000000000786ISI: 000352326900046PubMedID: 24950280OAI: oai:DiVA.org:uu-252158DiVA, id: diva2:810386
Available from: 2015-05-07 Created: 2015-05-04 Last updated: 2017-12-04Bibliographically approved

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