Predictive factors for the benefit of perioperative FOLFOX for resectable liver metastasis in colorectal cancer patients (EORTC Intergroup trial 40983)

Item Type:	Article
Title:	Predictive factors for the benefit of perioperative FOLFOX for resectable liver metastasis in colorectal cancer patients (EORTC Intergroup trial 40983)
Creators Name:	Sorbye, H. and Mauer, M. and Gruenberger, T. and Glimelius, B. and Poston, G.J. and Schlag, P.M. and Rougier, P. and Bechstein, W.O. and Primrose, J.N. and Walpole, E.T. and Finch-Jones, M. and Jaeck, D. and Mirza, D. and Parks, R.W. and Collette, L. and Cutsem, E.V. and Scheithauer, W. and Lutz, M.P. and Nordlinger, B.
Abstract:	OBJECTIVE: In EORTC study 40983, perioperative FOLFOX increased progression-free survival (PFS) compared with surgery alone for patients with initially 1 to 4 resectable liver metastases from colorectal cancer (CRC). We conducted an exploratory retrospective analysis to identify baseline factors possibly predictive for a benefit of perioperative FOLFOX on PFS. METHODS: The analysis was based on 237 events from 342 eligible patients. Cox proportional hazards regression models with a significance level of 0.1 were used to build up univariate and multivariate models. RESULTS: After adjustment for identified prognostic factors, moderately (5.1-30 ng/mL) and highly (>30 ng/mL) elevated carcinoembryonic antigen (CEA) serum levels were both predictive for the benefit of perioperative chemotherapy (interaction P = 0.07; hazard ratio [HR] = 0.58 and HR = 0.52 for treatment benefit). For patients with moderately or highly elevated CEA (>5 ng/mL), the 3-year PFS was 35% with perioperative chemotherapy compared to 20% with surgery alone. Performance status (PS) 0 and BMI lower than 30 were also predictive for the benefit of perioperative chemotherapy (interaction P = 0.04 and P = 0.02). However, the number of patients with PS 1 and BMI 30 or higher were limited. The benefit of perioperative therapy was not influenced by the number of metastatic lesions (1 vs 2-4, interaction HR = 0.98). CONCLUSIONS: Perioperative FOLFOX seems to benefit in particular patients with resectable liver metastases from CRC when CEA is elevated and when PS is unaffected, regardless of the number of metastatic lesions.ClinicalTrials.gov number NCT00006479.
Keywords:	Antineoplastic Combined Chemotherapy Protocols, Colorectal Neoplasms, Combined Modality Therapy, Fluorouracil, Leucovorin, Liver Neoplasms, Organoplatinum Compounds, Perioperative Care, Prognosis, Retrospective Studies
Source:	Annals of Surgery
ISSN:	0003-4932
Publisher:	Lippincott Williams & Wilkins
Volume:	255
Number:	3
Page Range:	534-539
Date:	March 2012
Official Publication:	https://doi.org/10.1097/SLA.0b013e3182456aa2
PubMed:	View item in PubMed

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