In the USA, systemic chemotherapy is often administered after liver resection for hepatic colorectal metastases.
This procedure is followed even though no clinical trials data directly support this practice.
The bias for chemotherapeutic treatment has made studies difficult.
Until recently, no well accepted staging systems existed to categorize these patients with liver metastases, who have greatly varied prognoses.
|Adjuvant chemotherapy is an independent predictor of outcomes|
|Journal of the American College of Surgeons|
Dr Rowan Parks and colleagues from New York assessed all liver resections from an American and European tertiary care center performed between 1991 and 1998.
The data were assembled from 2 prospective databases.
Of 792 liver resections, 518 patients were treated with no chemotherapy.
The research team compared these with 274 patients treated with fluorouracil-based adjuvant chemotherapy.
Patients treated by all other treatment regimens, including regional chemotherapy, were excluded.
The researchers also excluded patients who died perioperatively.
Patient survival analysis was performed by log-rank, with stratification by the clinical risk score, a staging system grading risk of recurrence by 5 clinical parameters.
The 5 clinical parameters included node-positive primary, short disease-free interval, large liver tumor, multiple liver tumors, and high carcinoembryonic antigen.
The researchers found that patients subjected to adjuvant chemotherapy had improved survival.
The team observed this improved survival even after stratification by clinical risk score.
In every clinical risk score category, patients subjected to adjuvant chemotherapy had a higher chance of survival.
The team noted that adjuvant chemotherapy was an independent predictor of outcomes.
Dr Parks' team concluded, "In this large study, patients were stratified by risk of recurrence."
"We found that systemic adjuvant chemotherapy, such as a fluorouracil-based regimen, prolongs survival after hepatic resection for colorectal metastases."