Updated Management of Colorectal Cancer Liver Metastases: Scientific Advances Driving Modern Therapeutic Innovations

EORTC/ESTRO defined induced oligopersistence of liver metastases from colorectal cancer - outcomes and toxicity profile of computer tomography guided high-dose-rate brachytherapy

Colorectal cancer (CRC) often leads to liver metastases, which may be resistant to systemic therapy. This study assessed outcomes and toxicity of computed tomography (CT) guided high-dose-rate (HDR) brachytherapy (BRT) in oligopersistent liver metastases from CRC. The study included patients with liver metastases classified as EORTC/ESTRO-defined induced oligopersistence after multiple systemic therapy lines. Up to four persistent liver metastases per patient were treated with CT-guided brachytherapy (CT-BRT). Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). The analysis focused on overall survival (OS), progression-free survival (PFS), tumor burden score (TBS), and the prognostic value of changes in metastasis size. Sixty-eight CRC patients were enrolled. During a median follow-up of 17 months, the median OS was 16 months, and the median PFS was 13 months. Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 7%, 35%, 44%, and 6% of patients, respectively. Patients with an objective response (ORR) of 42% had longer OS and PFS than those without it. OS was affected by lymph node metastases and metastasis size reduction, while PFS was additionally influenced by the administered dose. Multivariate analysis showed OS was linked to lymph node metastases (p = 0.001) and ORR (p = 0.004), and PFS to tumor burden score (TBS) difference (p = 0.017) and post-CT-BRT single metastasis size (p = 0.026). CT-BRT for CRC oligopersistent liver metastases is effective, improving PFS and OS, with TBS difference identified as a key response parameter for future strategies.

Automatic future remnant segmentation in liver resection planning

PURPOSE

Liver resection is a complex procedure requiring precise removal of tumors while preserving viable tissue. This study proposes a novel approach for automated liver resection planning, using segmentations of the liver, vessels, and tumors from CT scans to predict the future liver remnant (FLR), aiming to improve pre-operative planning accuracy and patient outcomes.

METHODS

This study evaluates deep convolutional and Transformer-based networks under various computational setups. Using different combinations of anatomical and pathological delineation masks, we assess the contribution of each structure. The method is initially tested with ground-truth masks for feasibility and later validated with predicted masks from a deep learning model.

RESULTS

The experimental results highlight the crucial importance of incorporating anatomical and pathological masks for accurate FLR delineation. Among the tested configurations, the best performing model achieves an average Dice score of approximately 0.86, aligning closely with the inter-observer variability reported in the literature. Additionally, the model achieves an average symmetric surface distance of 0.95 mm, demonstrating its precision in capturing fine-grained structural details critical for pre-operative planning.

CONCLUSION

This study highlights the potential for fully-automated FLR segmentation pipelines in liver pre-operative planning. Our approach holds promise for developing a solution to reduce the time and variability associated with manual delineation. Such method can provide better decision-making in liver resection planning by providing accurate and consistent segmentation results. Future studies should explore its seamless integration into clinical workflows.

Single cell analysis reveals that SPP1+ macrophages enhance tumor progression by triggering fibroblast extracellular vesicles

Patients with liver metastatic colorectal cancer (mCRC) have a poor prognosis and are the leading cause of death in colorectal cancer (CRC) patients, but the mechanisms associated with CRC metastasis have not been fully elucidated. In this study, we obtained data from the Gene Expression Omnibus database and characterized the single-cell profiles of CRC, mCRC and healthy samples at single-cell resolution, and explored the cells that influence CRC metastasis. We find that AQP1+ CRC identified as highly malignant tumor cells exhibited proliferative and metastatic characteristics. Immunosuppressive properties are present in the tumor microenvironment (TME), while NOTCH3+ Fib is identified to play a facilitating role in the metastatic colonization of CRC. Importantly, we reveal that tumor-associated macrophages (TAM) characterized by SPP1-specific high expression may be involved in TME remodeling through intercellular communication. Specifically, SPP1+ TAM mediates the generation of Fib-derived extracellular vesicle through the APOE-LRP1 axis, which in turn delivers tumor growth-promoting factors in the TME. This study deepens the understanding of the mechanism of TME in mCRC and lays the scientific foundation for the development of therapeutic regimens for mCRC patients.

Enhancing outcome prediction in patients with colorectal liver metastases undergoing hepatectomy: the synergistic impact of FIB-4 index and tumor burden score across KRAS profiles

BACKGROUND

The prognostic value of Fibrosis-4 (FIB-4) index, concerning KRAS status (wild-type [wtKRAS] vs. mutated [mutKRAS]) remains unclear in post-hepatectomy colorectal liver metastases (CRLM). We evaluated the combined impact of FIB-4 and Tumor Burden Score (TBS) on overall survival (OS)/recurrence-free survival (RFS), stratified by KRAS status.

METHODS

CRLM patients undergoing hepatectomy (2000-2020) were analyzed, grouped by TBS/FIB-4.

RESULTS

Among 828 patients, 196 had high FIB-4. High TBS had worse 5-year OS (P < 0.001). In wtKRAS, high TBS correlated with worse OS (P < 0.001), but not in mutKRAS. High FIB-4 correlated with worse OS (P = 0.01). Sub-stratification showed no OS difference by FIB-4 in wtKRAS, but a difference in mutKRAS (P = 0.03). Multivariable analysis identified mutKRAS (HR: 1.90), high TBS (HR: 1.62), and FIB-4 (HR: 1.15) as mortality risk factors. The TBS-FIB-4-KRAS index had highest predictive accuracy. For RFS, TBS and FIB-4 independently stratified outcomes. High TBS was associated with worse RFS in wtKRAS (P < 0.001) but not in mutKRAS. High FIB-4 decreased RFS in mutKRAS (P = 0.001) but not in wtKRAS. FIB-4 was associated with a 10% increased recurrence risk.

CONCLUSION

TBS and FIB-4, alongside KRAS status, should be considered to improve outcome predictions.

Advances in bevacizumab in colorectal cancer: a bibliometric analysis from 2004 to 2023

Background

Bevacizumab is a primary focus in the clinical application and research of metastatic colorectal cancer (mCRC) patients. This study aims to analyze publications on bevacizumab and CRC to explore and identify the trends and frontiers of this field.

Methods

We collected 4,164 articles on bevacizumab and CRC from the Web of Science Core Collection (WoSCC). CiteSpace, VOSviewer, R-bibliometrix, and Microsoft Excel were utilized for analysis and visualization.

Results

The United States, Japan, and China are the leading countries in this field. The National Cancer Institute and the University of Pisa share the top position for the highest number of publications. Personalized therapy, innovative combination treatments, mechanisms of resistance, and new drug development are enduring focal points and future research directions.

Conclusions

This study provides the first bibliometric analysis of research on bevacizumab and CRC, revealing the current status and future directions of this field.

Transarterial chemoembolisation with irinotecan (irinotecan-TACE) as salvage or post-inductive therapy for colorectal cancer liver metastases: effectiveness results from the CIREL study

BACKGROUND

A pan-European, prospective, observational study on the use of irinotecan-eluting transarterial chemoembolisation (irinotecan-TACE) was conducted to evaluate effectiveness outcomes in salvage and post-inductive/consolidation therapy settings of colorectal cancer liver metastases (CRLMs).

MATERIALS AND METHODS

One hundred and fifty-two patients were consecutively enrolled between February 2018 and August 2020. All patients received irinotecan-TACE for CRLMs. Response data were assessed by a central independent image review panel according to RECIST v1.1. Prognostic factors for overall survival (OS), hepatic progression-free survival (HPFS), and progression-free survival (PFS) were calculated using multivariable Cox regression. Health-related quality of life (HRQoL) at the first follow-up was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30).

RESULTS

One hundred and fifty-two (median age 66 years, 61% male) patients were prospectively enrolled. Overall, the median OS was 14.5 months [95% confidence interval (CI) 11.6-17.0 months]. The median OS (95% CI) of irinotecan-TACE as salvage therapy was 9.9 months (7.4-12.8 months) and the median PFS was 3.8 months (2.9-4.7 months). The median OS for post-inductive/consolidation therapy when used with systemic therapy or thermal ablation was 19.1 months (16.2-24.2 months), the median PFS was 6.0 months (4.5-8.7 months), and the median HPFS was 8.7 months (6.9-10.6 months).Following a multivariable analysis, negative prognostic factors for OS were Eastern Cooperative Oncology Group performance status ≥2 [hazard ratio (HR) 4.3], >50 mm lesion size (HR 2.1), progressive extrahepatic disease (HR 2.0), ≥2 prior systemic therapy lines (HR 2.4), >50% liver involvement (HR 8.5), and treatment plan not completed (HR 2.0). For PFS, progressive disease outside the liver (HR 1.8) and liver involvement of 25%-50% (HR 2.0) or >50% (HR 3.4) were identified as negative prognostic factors. HRQoL was generally stable or improved overall.

CONCLUSIONS

The results from the largest, pan-European, real-life study on irinotecan-TACE for CRLMs show a comparably long median OS when used as salvage therapy and promising HPFS when used with systemic therapy or thermal ablation as post-inductive/consolidation therapy. With its potential to maintain HRQoL, irinotecan-TACE could be further integrated into systemic treatment pathways.

Genomic and micro-environmental insights into drug resistance in colorectal cancer liver metastases

BACKGROUND

Colorectal cancer (CRC) is known for its high heterogeneity, with liver metastases significantly impairing survival outcomes. Understanding the tumor microenvironment (TME) and genomic alterations in metastatic sites is crucial for developing personalized therapies that overcome drug resistance and improve prognosis.

METHODS

We profiled 54 CRC liver metastases, comparing them with 198 other metastatic lesions and normal liver tissues. By analyzing immune cell infiltration, stromal interactions, and key genomic alterations, we constructed an 11-gene prognostic model to predict survival and immunotherapy outcomes.

RESULTS

CRC liver metastases with high-risk profiles demonstrated enriched follicular helper T cells, activated dendritic cells, and M2 macrophages in the TME. Frequent mutations in APC, TP53, KRAS, and PIK3CA were identified, alongside altered EGFR signaling. The 11-gene model effectively stratified patients by prognosis and predicted immunotherapy responses, emphasizing the therapeutic potential of targeting resistance mechanisms.

CONCLUSIONS

This study reveals how genomic and TME-driven factors contribute to drug resistance in CRC liver metastases. Integrating these insights with clinical data could advance precision therapies, addressing the evolving challenge of tumor drug resistance in CRC.

Metastatic tumor growth in steatotic liver is promoted by HAS2-mediated fibrotic tumor microenvironment

Steatotic liver enhances liver metastasis of colorectal cancer (CRC), but this process is not fully understood. Steatotic liver induced by a high-fat diet increases cancer-associated fibroblast (CAF) infiltration and collagen and hyaluronic acid (HA) production. We investigated the role of HA synthase 2 (HAS2) in the fibrotic tumor microenvironment in steatotic liver using Has2ΔHSC mice, in which Has2 is deleted from hepatic stellate cells. Has2ΔHSC mice had reduced steatotic liver-associated metastatic tumor growth of MC38 CRC cells, collagen and HA deposition, and CAF and M2 macrophage infiltration. We found that low-molecular weight HA activates Yes-associated protein (YAP) in cancer cells, which then releases connective tissue growth factor to further activate CAFs for HAS2 expression. Single-cell analyses revealed a link between CAF-derived HAS2 and M2 macrophages and CRC cells through CD44; these cells were associated with exhausted CD8+ T cells via programmed death-ligand 1 and programmed cell death protein 1 (PD-1). HA synthesis inhibitors reduced steatotic liver-associated metastasis of CRC, YAP expression, and CAF and M2 macrophage infiltration, and improved response to anti-PD-1 antibody. In conclusion, steatotic liver modulates a fibrotic tumor microenvironment to enhance metastatic cancer activity through a bidirectional regulation between CAFs and metastatic tumors, enhancing the metastatic potential of CRC in the liver.

Chitosan nanoparticles of imatinib mesylate coated with TPGS for the treatment of colon cancer: In-vivo & in-vitro studies

The study aimed to develop and evaluate chitosan-based nanoparticles coated with TPGS for the targeted delivery of imatinib mesylate to colon cancer cells. Particle size and zeta potential analysis were within the acceptable range for targeting colon cancer. CS-IMT-TPGS-NPs had a significant positive zeta potential of 30.4 mV, suggesting improved cellular intake. FE-SEM and TEM demonstrated that the nanoparticles appeared spherical, smooth, and did not aggregate, with a visible TPGS coating. XRD confirmed that crystalline imatinib transitioned to an amorphous state during nano formulation. In-vitro tests on HCT-116 cells demonstrated that CS-IMT-TPGS-NPs outperformed free IMT regarding cytotoxicity, apoptosis induction, cellular uptake, and cell migration inhibition. Additionally, the nanoparticles were examined in vitro using mitochondrial membrane potential, DNA fragmentation, GAPDH relative gene expression, ROS estimation, and cell cycle analysis. The effect of therapy on expected colon-associated bacterial strains was also investigated. The biocompatibility of nanoparticles was assessed by hemolysis and platelet aggregation experiments. The anti-inflammatory impact was determined using the HET-CAM test. Non-Fickian diffusion at pH 5.5 resulted in sustained in-vitro drug release, with no initial burst. In-vivo investigations using albino Wistar rats suggest pharmacokinetic properties for produced nanoparticles, whereas histopathological examinations assess acute toxicity.

Predictive value of preoperative circulating tumor cells combined with hematological indexes for liver metastasis after radical resection of colorectal cancer

Colorectal cancer is one of the most common malignant tumors in the world, and about 50% of its advanced patients will have liver metastasis. Preoperative assessment of the risk of liver metastasis in patients with colorectal cancer is of great significance for making individualized treatment plans. Traditional imaging examinations and tumor markers have some limitations in predicting the risk of liver metastasis. Therefore, it is of great clinical value to explore more sensitive and specific predictive indicators for improving early detection and treatment effect. In recent years, circulating tumor cells (CTCs), as a new biomarker, have attracted much attention because of their close relationship with tumor metastasis and prognosis. The purpose of this study is to collect and analyze the data of colorectal cancer patients treated in our hospital, so as to determine the predictive value of circulating tumor cells before operation and related hematological indexes for liver metastasis after radical resection of colorectal cancer, and to establish the corresponding prediction model to provide gastrointestinal surgeons with more accurate identification of high-risk patients and guidance for treatment. A total of 88 patients were included in this study, and 26 of whom developed liver metastasis after colorectal cancer surgery. The possible related factors are included in the single factor logistic regression, and the results are obtained after analysis. Body mass index, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9, tumor marker CA72-4 (CA72-4), cytokeratin-7 (CK-7), CTC count, and neutrophil-to-lymphocyte ratio (P < .2) are risk factors for liver metastasis after radical resection of colorectal cancer. Furthermore, the data obtained were included in multivariate regression analysis, and CEA, CA72-4, CK-7, and CTC counts were independent risk factors for liver metastasis after radical resection of colorectal cancer (P < .05). This study confirmed that CEA, CA72-4, CK-7, and CTC counts are independent risk factors for liver metastasis after radical resection of colorectal cancer. In addition, the prediction model of this study can help gastrointestinal surgeons accurately identify patients who are prone to liver metastasis after colorectal cancer surgery.

Comparative evaluation of non-contrast MRI versus gadoxetic acid-enhanced abbreviated protocols in detecting colorectal liver metastases

PURPOSE

This study compares the diagnostic efficacy of non-contrast abbreviated MRI protocols with Gadoxetic acid-enhanced abbreviated MRI for detecting colorectal liver metastasis (CRLM), focusing on lesion characterization and surveillance.

METHODS

Ninety-four patients, including 55 with pathologically verified CRLM, were enrolled, totaling 422 lesions (287 metastatic, 135 benign). Two independent readers assessed three MRI protocols per patient: Protocol 1 included non-contrast sequences (T2-weighted turbo spin-echo, T1-weighted Dixon, diffusion-weighted imaging (DWI), and ADC mapping). Protocol 2 included gadoxetic acid enhancement with hepatobiliary phase imaging, T2 TSE, DWI, and ADC maps. Protocol 3 utilized the standard Gadoxetic Acid-enhanced MRI sequence, which included pre-contrast T1-weighted imaging, T1-weighted Dixon sequences, post-contrast T1-weighted imaging (including arterial, portal venous, transitional and hepatobiliary phases), and additional T2-weighted and DWI sequences. Diagnoses were scored on a 5-point scale (benign = 1; malignant = 5), with scores ≥ 3 indicating CRLM. ROC curves analyzed diagnostic accuracy, comparing area under the curve (AUC) values across protocols.

RESULTS

No significant difference in AUCs was observed between Protocol 1 (0.899-0.909) and Protocol 2 (0.906-0.931) versus Protocol 3 (0.935-0.939) (p = 0.091-0.195). For lesions ≤ 10 mm, Protocol 1 was slightly inferior to Protocol 3 (p = 0.002-0.032), while Protocol 2 remained comparably effective (p = 0.096-0.179). These findings held when using a threshold of ≥ 4 to define CRLM.

CONCLUSION

The non-enhanced abbreviated MRI protocol is as effective as the gadoxetic acid-enhanced protocol in identifying CRLM. The proposed Ab-MRI approach may be a viable alternative for CRLM surveillance.

CRITICAL RELEVANCE STATEMENT

The non-enhanced abbreviated MRI (Ab-MRI) protocol is as effective as the gadoxetic acid-enhanced protocol in identifying colorectal liver metastasis (CRLM). The proposed Ab-MRI approach may be a viable alternative for CRLM surveillance.

KEY POINTS

Two abbreviated protocols are proposed for colorectal liver metastasis (CRLM) surveillance. The non-enhanced protocol showed equivalent efficacy and was more cost-effective. The non-enhanced protocol may be a viable alternative for CRLM surveillance.

Efficacy of adjuvant chemotherapy after curative hepatectomy for patients with colorectal cancer liver metastases: a single-center retrospective study

BACKGROUND

The survival benefit of adjuvant chemotherapy after curative hepatectomy for colorectal cancer (CRC) liver metastases remains controversial. This retrospective study aimed to evaluate the efficacy of adjuvant chemotherapy in improving recurrence-free survival (RFS) and overall survival (OS) in patients who underwent curative hepatectomy for CRC liver metastases at a tertiary medical center.

METHODS

We retrospectively analyzed clinicopathological factors in 89 patients (surgery alone, n = 63; adjuvant chemotherapy, n = 26) who underwent curative hepatectomy for CRC liver metastases from January 2010 to December 2022. Patients who received neoadjuvant therapy or prior hepatectomy were excluded to minimize patient heterogeneity. Multivariate analysis using Cox proportional hazards regression was conducted to assess the independent effect of adjuvant therapy on RFS and OS.

RESULTS

The 3-year RFS rates were 22.6% in the surgery alone group and 29.6% in the adjuvant chemotherapy group (hazard ratio, 0.71; 95% confidence interval, 0.43-1.21; p = 0.102). The 3-year OS rates were 72.3% in the surgery alone group and 88.5% in the adjuvant chemotherapy group (hazard ratio, 0.59; 95% confidence interval, 0.29-1.25; p = 0.17). Univariate analyses showed that the number of liver metastases (> 2) was significantly associated with poorer OS (hazard ratio, 2.44; 95% confidence interval, 1.11-5.37; p = 0.027). Additionally, multivariate analyses showed that the addition of adjuvant chemotherapy was significantly associated with improved OS (hazard ratio, 0.23; 95% confidence interval, 0.07-0.81; p = 0.021).

CONCLUSIONS

Adjuvant chemotherapy may improve OS after curative hepatectomy for CRC liver metastases, though it did not significantly impact RFS. Larger-scale multicenter prospective studies with stratified analyses are needed to confirm these findings.

Patterns and Predictors of Recurrence After Curative Resection of Colorectal Liver Metastasis (CRLM)

BACKGROUND

Our study aims to determine the predictors and patterns of relapses after curative colorectal liver metastasis (CRLM) resection.

METHODS

A single-centre, retrospective study of CRLM patients operated between 2010 and 2022 was performed. The site of first recurrence was either hepatic (marginal (≤ 1 cm) or extramarginal), extrahepatic, or both. Factors that predicted relapse patterns and overall survival were determined by multivariable Cox regression analysis with backward elimination of variables.

RESULTS

The study consisted of 258 patients, with a similar proportion of synchronous (144; 56%) and metachronous(114; 43%) metastasis. At a 43-month median follow-up, 156 patients (60.4%) developed recurrences with 33 (21.1%) in the liver, 62(24.03%) extra-hepatic recurrences, and 58 (22.48%) having both. Isolated marginal liver relapses were seen in seven (9.89%) liver recurrence patients. The median overall and relapse-free survivals were 38 months (30-54) and 13 months (11-16), respectively. The 3-year liver-relapse-free survival was 54.4% (44.9-60.6). Size of liver metastases > 5 cm (HR 2.06 (1.34-3.17), involved surgical margins (HR 2.16 (1.27-3.68)), and adjuvant chemotherapy (HR 1.89 (1.07-3.35)) were predictors of hepatic recurrences. Node positivity of primary (HR 1.61 (1.02-2.56)), presence of baseline extra-hepatic metastases (HR 0.30 (0.18-0.51)), size of liver metastases > 5 cm (HR 2.02 (1.37-2.99)), poorly differentiated histology (HR 2.25 (1.28-3.49)), presence of LVI (HR 2.25 (1.28-3.94)), and adjuvant chemotherapy (HR 2.15 (1.28-3.61)) were predictors of extra-hepatic recurrences.

CONCLUSION

The study found majority relapses occurred at extrahepatic sites whilst isolated marginal recurrences were few. The consistent predictors of recurrence were size and inability to deliver adjuvant therapy. A tailored adjuvant therapy might improve outcomes after liver metastasectomy in colorectal cancers.

Biomarkers of systemic treatment response: MR images of intratumoral fat deposition in colorectal liver metastases (CRLM) after chemotherapy

PURPOSE

Colorectal cancer cells containing mobile lipids are said to be an early indicator of chemotherapy effects. The objective of the study was to examine the frequency and clinical relevance of intratumoral fat deposition in colorectal liver metastases (CRLM) post-chemotherapy using dual-echo chemical shift gradient-echo magnetic resonance imaging (MRI).

METHODS

A retrospective analysis of 98 patients with CRLM diagnosed between 2017 and 2022 (69 M, mean age 62.87 ± 10.73 years old) who had an MRI after chemotherapy was performed. On dual-echo chemical shift gradient-echo MRI, intratumoral fat deposition of CRLM was evaluated. A signal intensity drop of ≥ 12% in opposed-phase images vs. in-phase images indicated intratumoral fat. After chemotherapy, the presence of fat deposition was correlated with patients' overall survival.

RESULTS

Before and after chemotherapy, 0 (0%) and 29 (29.59%) patients exhibited intratumoral fat. The number of CRLM ranged from 1 to 25 with a median of 3 and a mean size of 32.58 ± 22.95 mm. The groups had statistically different survival times. Overall survival was shorter for patients with intratumoral fat deposition in CRLM (32 months (24-60, 95% CI)) than for patients without fat deposition in CRLM (48 months (36-NA, 95% CI)).

CONCLUSION

In our group, nearly 30% of CRLM patients exhibited intratumoral fat after chemotherapy. Patients with intratumoral fat deposition in CRLM have a shorter overall survival time. The presence of fat in CRLM correlates with a poor long-term prognosis.

Do Surgical Oncology Multidisciplinary Team Meetings Make a Difference?

BACKGROUND

Multidisciplinary team (MDT) meetings are important but resource-expensive components of surgical and oncologic care. This cohort study investigated the effectiveness of surgical MDT meetings by assessing the predictability of MDT meeting recommendations, the degree that patient management plans are changed by discussion, and the incidence of recommendation implementation.

METHODS

Multidisciplinary team meetings at The Queen Elizabeth Hospital in South Australia were audited for upper gastrointestinal (UGI) and colorectal (CR) surgical units from August 2021 to June 2022. All cases referred for MDT meeting discussion were included. Prospectively obtained pre-MDT meeting management plans were compared with formal MDT meeting recommendations to assess for concordance and degree of change. Patient records were assessed after 8 months for MDT meeting recommendation implementation. Multivariable analysis of patient factors was performed to identify associations between MDT meeting recommendation predictability and implementation.

RESULTS

In 438 patient cases, discussed during 30 MDT meetings, 317 (72.37%) were correctly predicted. Specifically, 226 (51.6%) were correct with no change, 28 (6.39%) were correct with minor changes, 40 (9.13%) were correct with moderate changes, and 23 (5.25%) were correct with major changes. The UGI and CR cohorts differed significantly in moderate changes (P = 0.0217). The female patients were 1.62 times more likely than the male patients to have pre-MDT meeting management plans predicted (P = 0.0201). Formal MDT meeting recommendations were implemented in 380 (89.62%) cases.

CONCLUSIONS

The MDT meetings changed management for almost 1 in 2 patients discussed. Other than female sex, no identifiable patient factors increased the likelihood of predictability, and no factors predicted recommendation implementation.

Prognostic factors associated with early recurrence following liver resection for colorectal liver metastases: a systematic review and meta-analysis

BACKGROUND

Colorectal cancer (CRC) is the 3rd most common malignancy with the liver being the most common site of metastases. The recurrence rate of colorectal liver metastases (CRLM) after liver resection (LR) is notably high, with an estimated 40% of patients experiencing recurrence within 6 months. In this context, we conducted a meta-analysis to synthesize and evaluate the reliability of evidence pertaining to prognostic factors associated with early recurrence (ER) in CRLM following LR.

METHODS

Systematic searches were conducted from the inception of databases to July 14, 2023, to identify studies reporting prognostic factors associated with ER. The Quality in Prognostic Factor Studies (QUIPS) tool was employed to assess risk-of-bias for included studies. Meta-analysis was then performed on these prognostic factors, summarized by forest plots. The grading of evidence was based on sample size, heterogeneity, and Egger's P value.

RESULTS

The study included 24 investigations, comprising 12705 individuals, during an accrual period that extended from 2007 to 2023. In the evaluation of risk-of-bias, 22 studies were rated as low/moderate risk, while two studies were excluded because of high risk. Most of the studies used a postoperative interval of 6 months to define ER, with 30.2% (95% confidence interval [CI], 24.1-36.4%) of the patients experiencing ER following LR. 21 studies were pooled for meta-analysis. High-quality evidence showed that poor differentiation of CRC, larger and bilobar-distributed liver metastases, major hepatectomy, positive surgical margins, and postoperative complications were associated with an elevated risk of ER. Additionally, moderate-quality evidence suggested that elevated levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA199), lymph node metastases (LNM) of CRC, and a higher number of liver metastases were risk factors for ER.

CONCLUSION

This review has the potential to enhance the efficacy of surveillance strategies, refine prognostic assessments, and guide judicious treatment decisions for CRLM patients with high risk of ER. Additionally, it is essential to undertake well-designed prospective investigations to examine additional prognostic factors and develop salvage therapeutic approaches for ER of CRLM.