American Surgical Association Home American Surgical Association Annual Meeting
Search Meeting Site Only



Current Meeting Home
Program
Past & Future Meetings

 

 





 

Back to Annual Meeting Program


Adjuvant Chemotherapy with Folfox for Primary Colorectal Cancer is associated with Increased Somatic Gene Mutations and Inferior Survival in Patients Undergoing Hepatectomy for Metachronous Liver Metastases
Jean-Nicolas Vauthey, Andreas Andreou*, Dipen M Maru*, Su Chen*, Eddie K Abdalla*, Steven A Curley, Christopher Garrett*, Michael Overman*, Thomas A Aloia*, Scott Kopetz*
MD Anderson Cancer Center, Houston, TX

OBJECTIVE: We hypothesized that metachronous colorectal liver metastases (CLM) have different biology after failure of oxaliplatin (FOLFOX) compared to 5-fluorouracil (5-FU) or no chemotherapy for adjuvant treatment of stage II/III colorectal cancer (CRC).
METHODS: We identified 371 patients who underwent hepatectomy for metachronous CLM (disease-free interval≥12m, 1993-2010). Mass-spectroscopy genotyping for KRAS, BRAF, NRAS, PIK3CA, CTNNB1, and PDGFRA in liver metastases was performed in a subset of 129 patients.
RESULTS: Adjuvant treatment for primary CRC was 5-FU in 169 patients, FOLFOX in 77 and no chemotherapy in 95. Node-positive primary was comparable between FOLFOX and 5-FU but lower in the no-chemotherapy group (P<0.0001). Median metastasis size was smaller in the adjuvant FOLFOX-group (2.5cm) compared to 5-FU (3.0cm) or no-chemotherapy (3.5cm), (P=0.008) although prehepatectomy chemotherapy utilization, metastases number, and carcinoembryonic antigen were similar. Disease-free survival (DFS) and overall survival (OS) after hepatectomy were worse with adjuvant FOLFOX (Figure; DFS at 3-years: 14% vs. 38%[5-FU] vs. 45%[no-chemo], OS at 3-years: 58% vs. 70%[5-FU] vs. 84%[no-chemo]). In multivariate analysis, adjuvant FOLFOX was associated with worse DFS (P<0.0001) and OS (P<0.0001). Mutation analysis revealed ≥1 mutations in 62% of patients (29/47) after FOLFOX, 39% (16/41) after 5-FU, and 37% (15/41) without chemotherapy (P=0.03).
CONCLUSION: Adjuvant FOLFOX chemotherapy for primary CRC is associated with a high rate of somatic mutations in liver metastases and inferior outcomes after hepatectomy for metachronous CLM.


Back to Annual Meeting Program

 



© 2021 American Surgical Association. All Rights Reserved. Privacy Policy.