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Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy
Author(s) -
Auer Rebecca C.,
White Rebekah R.,
Kemeny Nancy E.,
Schwartz Lawrence H.,
Shia Jinru,
Blumgart Leslie H.,
DeMatteo Ronald P.,
Fong Yuman,
Jarnagin William R.,
D'Angelica Michael I.
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24912
Subject(s) - medicine , chemotherapy , carcinoembryonic antigen , magnetic resonance imaging , colorectal cancer , radiology , odds ratio , cancer , multivariate analysis , surgery
BACKGROUND: During chemotherapy, some colorectal liver metastases (LMs) disappear on serial imaging. This disappearance may represent a complete response (CR) or a reduction in the sensitivity of imaging during chemotherapy. The objective of the current study was to determine the fate of disappearing LMs (DLMs) and the factors that predict a true CR. METHODS: Between 2000 and 2003, 435 patients who were evaluated by hepatobiliary surgeons received chemotherapy before they were considered for resection. Inclusion criteria were <12 LMs before chemotherapy, at least 1 DLM on a computed tomography (CT) scan, and either surgical resection or 1 year of clinical follow‐up after the disappearance of LMs. A true CR was defined as either a pathologic CR (no tumor detected in the resection specimen) or a durable clinical CR (did not reappear on follow‐up imaging). Clinical and pathologic factors were analyzed to identify those associated with a true CR. RESULTS: During chemotherapy, 39 patients (9%) had a total of 118 DLMs on follow‐up CT scans. Sixty‐eight DLMs were resected, and 50 were followed clinically. Overall, 75 DLMs (64%) were true CRs, including 44 pathologic CRs and 31 durable clinical CRs. On multivariate analysis, the use of hepatic arterial infusion (HAI) chemotherapy (odds ratio [OR], 6.2; P = .02), the inability to observe the DLM on a magnetic resonance image (OR, 4.7; P = .005), and normalization of serum carcinoembryonic antigen levels (OR, 4.6; P = .006) were associated independently with a true CR. CONCLUSIONS: Approximately 66% of DLMs represented a true CR according to assessment by resection or radiologic follow‐up. Predictive factors may help to stratify patients who are likely to harbor residual disease. Cancer 2010. © 2010 American Cancer Society.