Preoperative chemotherapy in upfront resectable colorectal liver metastases: New elements for an old dilemma?

IF 11.3 1区化学 Q1 CHEMISTRY, PHYSICAL ACS Catalysis Pub Date : 2024-02-07 DOI:10.1016/j.ctrv.2024.102696

Lorenzo Bernardi , Raffaello Roesel , Davit L. Aghayan , Pietro E. Majno-Hurst , Sara De Dosso , Alessandra Cristaudi

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Abstract

The use of preoperative or “neoadjuvant” chemotherapy (NAC) has long been controversial for resectable colorectal liver metastases (CRLM). The European Society of Medical Oncology (ESMO) 2023 guidelines on metastatic colorectal cancer (CRC) indicate a combination of surgical/technical and oncologic/prognostic criteria as the two determinants for allocating patients to NAC or upfront hepatectomy. However, surgical and technical criteria have evolved, and oncologic prognostic criteria date from the pre-modern chemotherapy era and lack prospective validation.

The traditional literature is interpreted as not supporting the use of NAC because several studies fail to demonstrate a benefit in overall survival (OS) compared to upfront surgery; however, OS may not be the most appropriate endpoint to consider. Moreover, the commonly quoted studies against NAC contain many limitations that may explain why NAC failed to demonstrate its value. The query of the recent literature focused primarily on other aspects than OS, such as surgical technique, the impact of side effects of chemotherapy, the histological growth pattern of metastases, or the detection of circulating tumor DNA, shows data that support a more widespread use of NAC. These should prompt a critical reappraisal of the use of NAC, leading to a more precise selection of patients who could benefit from it.

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前期可切除结直肠肝转移瘤的术前化疗：旧难题的新要素？

对于可切除的结直肠肝转移瘤（CRLM），术前化疗或 "新辅助 "化疗（NAC）的使用一直存在争议。欧洲肿瘤内科学会（ESMO）2023 年转移性结直肠癌（CRC）指南指出，手术/技术标准和肿瘤学/预后标准相结合是决定患者接受新辅助化疗还是先期肝切除术的两个因素。传统文献被解释为不支持使用 NAC，因为有几项研究未能证明与先期手术相比，NAC 在总生存期（OS）方面有优势；然而，OS 可能并不是最合适的考虑终点。此外，常被引用的反对 NAC 的研究存在许多局限性，这可能是 NAC 未能证明其价值的原因。对近期文献的查询主要集中在OS以外的其他方面，如手术技术、化疗副作用的影响、转移瘤的组织学生长模式或循环肿瘤DNA的检测，这些数据都支持更广泛地使用NAC。这些数据应促使人们对 NAC 的使用进行批判性的重新评估，从而更准确地选择可从 NAC 中获益的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Catalysis CHEMISTRY, PHYSICAL-

CiteScore

20.80

自引率

6.20%

发文量

1253

审稿时长

1.5 months

期刊介绍： ACS Catalysis is an esteemed journal that publishes original research in the fields of heterogeneous catalysis, molecular catalysis, and biocatalysis. It offers broad coverage across diverse areas such as life sciences, organometallics and synthesis, photochemistry and electrochemistry, drug discovery and synthesis, materials science, environmental protection, polymer discovery and synthesis, and energy and fuels. The scope of the journal is to showcase innovative work in various aspects of catalysis. This includes new reactions and novel synthetic approaches utilizing known catalysts, the discovery or modification of new catalysts, elucidation of catalytic mechanisms through cutting-edge investigations, practical enhancements of existing processes, as well as conceptual advances in the field. Contributions to ACS Catalysis can encompass both experimental and theoretical research focused on catalytic molecules, macromolecules, and materials that exhibit catalytic turnover.