Transplant improves survival for certain patients with colorectal cancer liver metastases
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Key takeaways:
- Researchers reported a 10-year OS rate of 80% with liver transplant in selected cases of colorectal cancer liver metastases.
- Establishment of living donor programs may aid in liver donor organ scarcity.
Liver transplant conferred a 10-year OS rate of more than 80% in selected patients with colorectal cancer and nonresectable liver metastases, study results showed.
Researchers also identified several predictive factors that had a negative impact on OS among liver transplant recipients, according to data published in JAMA Surgery.
“Liver transplantation is the best medical treatment option in patients with colorectal cancer with nonresectable liver-only metastases,” Svein Dueland, MD, PhD, an oncologist in the transplant oncology research group and department of transplantation medicine at Oslo University Hospital, told Healio. “The problem worldwide is scarcity of liver donor organs.”
Background
The liver is the most common site for metastatic disease among individuals with colorectal cancer, Dueland and colleagues wrote.
“Liver transplantation for [patients with colorectal cancer] with liver metastases was abandoned in the 1990s due to poor survival,” Dueland said. “We wanted to reexamine if liver transplantation could result in longer overall survival in selected patients with colorectal cancer and liver-only metastases.”
Methodology
Dueland and colleagues conducted a nonrandomized controlled trial to determine predictive factors for long-term survival or cure after liver transplantation among individuals with colorectal cancer and liver-only metastases.
The prospective study included data from three clinical trials of liver transplant for colorectal liver metastases conducted at Oslo University Hospital between 2006 and 2020.
Although the trials had different inclusion criteria, they had a similar follow-up protocol to determine disease recurrence, OS and survival after disease relapse, the investigators noted.
Researchers performed a final data analysis on Dec. 31, 2021, of 61 patients (median age, 57.8 years; range, 28.7-71.1; 57.4% men) who participated in all relevant liver transplant trials.
DFS, OS and survival time after recurrence served as the study’s primary outcome measurements. Post-transplant follow-up observation time ranged from 16 to 165 months.
Key findings
Investigators reported median DFS of 11.8 months (95% CI, 9.3-14.2), median OS of 60.3 months (95% CI, 44.3-76.4) and median RFS of 37.1 months (95% CI, 4.6-69.5).
Individuals with an Oslo risk score of 0 had a 10-year OS rate of 88.9%. Similarly, those with a Fong Clinical Risk Score of 1 had a 10-year OS rate of 80%.
Negative predictors factors for OS included largest tumor size greater than 5.5 cm (P < .001), progressive disease while receiving chemotherapy (P = .02), plasma carcinoembryonic antigen values greater than 80 g/L (P <.001), liver metabolic tumor volume on PET of greater than 70 cm3 (P < .001), primary tumor in the ascending colon (P < .001), tumor burden score of 9 or higher (P = .02), and nine or more liver lesions (P = .02).
Clinical implications
The results suggest that — based on several clinical predictive factors — a 10-year OS of 80% or higher can be achieved after liver transplant for colorectal cancer metastases in highly selected cases, according to Dueland.
“Establishing living donor programs may expand the number of donor liver grafts available for liver transplantation in patients with colorectal cancer,” he told Healio.
The patient population examined in the study by Dueland and colleagues only accounted for 61 transplants over a 14-year period, with patients surviving a median of 21 months from diagnosis to transplant, according to Ryan J. Ellis, MD, MS, and Michael I. D’Angelica, MD, from the department of surgery at Memorial Sloan Kettering Cancer Center.
“Such a long interval with liver-only disease and no significant progression while remaining healthy enough for a liver transplant is indeed a rare event,” they wrote in an accompanying editorial. “This radical alteration of the denominator by selection with time and observation while receiving chemotherapy can easily make survival percentages look impressive.”
Despite their critique, Ellis and D’Angelica praised the Norwegian researchers for their continued research on the utility of organ transplant for individuals with metastatic colorectal cancer.
“It seems likely that there is a small group of patients with unresectable colorectal liver metastases who should be considered for transplant, and long-term survival and possibly cure are achievable in these patients with appropriate selection,” they wrote. “We all will need to keep a sharp eye out for these patients — they might be hard to find!”
References:
- Dueland S, et al. JAMA Surg. 2023;doi:10.1001/jamasurg.2023.2932.
- Ellis RJ, et al. JAMA Surg. 2023;doi:10.1001/jamasurg.2023.2933.
For more information:
Svein Dueland, MD, PhD, can be reached at Oslo University Hospital, Section for Transplantation Surgery, Department of Transplantation Medicine, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; email: svedue@ous-hf.no.
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