Certain patients with colorectal cancer that has metastasized to the liver may experience improved progression-free survival with liver transplantation compared with standard therapies, according to a recent study published by Byrne et al in JAMA Surgery.
Background
Colorectal cancer often metastasizes to the liver, and for some patients, surgical resection of their hepatic tumors may not be an option.
Although previous studies have shown the benefits of liver transplantation in these patients, this is one of the first studies to compare liver transplantation to other treatment options.
“In any cancer treatment, it's very easy to describe the outcomes of the patients who received the intervention, but similar patients that did not undergo the intervention can serve as a good comparison,” explained lead study author Matthew Byrne, MD, a surgery resident at the University of Rochester Medical Center. “Without randomized, controlled trial data, this study offers the best evidence that is available to understand whether liver transplantation provides better outcomes over other treatments,” he added.
Study Methods and Results
In the recent study, the researchers examined the outcomes of 33 patients whose colorectal cancer was under control but who had hepatic tumors that could not be surgically removed. All of the patients were eligible for liver transplantation, but only 20 of them chose to undergo the procedure, whereas 13 of them opted for standard therapies such as removal of part of the liver, chemotherapy, or liver-directed therapies.
After a follow-up of 3 years, the researchers discovered that compared with those who opted for standard treatments, the patients who underwent liver transplantation experienced higher progression-free survival rates. After 1, 2, and 3 years posttransplant, a respective 90%, 73%, and 36% of the patients had no signs of cancer progression. Conversely, only 42% of the patients who opted for standard therapies experienced no cancer progression after 1 year. This number declined to about 10% after 2 and 3 years following treatment.
Despite demonstrating a higher overall survival rate in the transplantation group compared with the standard therapy group, the researchers noted that the difference was not statistically significant. After a follow-up of 3 years, the transplant recipients experienced a 90% rate of overall survival vs 73% among those who received standard therapies.
Conclusions
“Unfortunately, liver transplantation is not for every single patient who has advanced metastatic disease in the liver,” indicated senior study author Roberto Hernandez-Alejandro, MD, Chief of Abdominal Transplant and Liver Surgery at the University of Rochester Medical Center. “The way we can have good results and help these patients is by establishing strict criteria based on tumor biology, the behavior of these tumors, how well they respond to chemotherapy. We only perform transplants for patients who are likely to have a good outcome,” he underscored.
The researchers concluded that larger clinical trials may be needed to fully understand the added benefit of liver transplantation compared with standard treatments in this patient population and to better determine which patients may benefit the most.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
