Liver transplant bests chemotherapies for improved survival in colorectal liver metastasis
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Key takeaways:
- Patients who underwent LT vs. chemotherapy-based multimodal therapy had significantly higher progression-free survival at 1, 2 and 3 years.
- Overall survival also was higher with LT.
Patients who underwent liver transplantation vs. alternative therapy for unresectable colorectal liver metastasis had higher progression-free and overall survival, as well as lower rates of recurrence, researchers reported in JAMA Surgery.
“Studies have shown acceptable outcomes for well-selected patients with unresectable colorectal liver metastasis (uCRLM) treated with total hepatectomy and liver transplant,” Matthew M. Byrne, MD, of the department of surgery at Rochester Medical Center, and colleagues wrote. “Transplant oncology relies on meticulous selection and understanding of tumor biology, but absence of an acceptable comparative group undermines effectiveness evaluation.”
In a single-institution cohort study, the researchers enrolled 195 patients with uCRLM referred for LT evaluation at the University of Rochester between 2019 and 2023. Of those, 33 patients (mean age, 43.5 years; 52% women) were eligible for LT.
Byrne and colleagues compared progression-free survival and overall survival among those who underwent LT (n = 20) vs. those who declined LT and received alternative therapy (n = 13).
All patients in the alternative therapy group continued systemic chemotherapy, alone or with hepatic artery infusion pump, liver resection or locoregional therapies such as microwave and radiofrequency ablations.
According to study results, progression-free survival was significantly higher in the LT group vs. the alternative therapy group at 1 year (90% vs. 41.7%), 2 years (72.7% vs. 10.4%) and 3 years (36.4% vs. 10.4%). Overall survival also was higher at each time point — 100% vs. 83.9% at 1 year and 90% vs. 73.4% at 2 and 3 years.
The researchers reported that one patient (5%) in the LT group experienced recurrence vs. three patients (23%) in the alternative therapy group.
“Application of LT selection criteria for patients with uCRLM demonstrated higher progression-free survival for patients receiving LT vs. patients choosing alternative therapy,” Byrne and colleagues wrote. “Patients with uCRLM should be referred for multidisciplinary evaluation to transplant oncology centers with strict LT criteria.”
They continued: “We call for collaborations, including North America-based, large observational studies and randomized clinical trials, to further clarify the effectiveness and selection of LT for uCRLM.”
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