HPB
Lily V. Saadat, MD
Resident/Research Fellow
Memorial Sloan Kettering Cancer Center
Boston, Massachusetts, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Use of hepatic arterial infusion combined with systemic chemotherapy (HAI-SYS) for patients with unresectable colorectal liver-confined metastases (CRLM) is associated with improved oncologic outcomes and high conversion to resection. The role of HAI-SYS in patients with extrahepatic disease (EHD) remains controversial.
Methods:
This retrospective chart review identified consecutive patients with unresectable CRLM treated with HAI-SYS at a single center from 2000-2020. EHD at any timepoint prior to pump placement was characterized as “indeterminate” or “suspicious”, based on pathologic or radiographic features. Overall survival (OS) and hepatic progression were calculated from the time of HAIP until death or first liver progression, respectively.
Results:
A total of 926 patients with unresectable CRLM were included, with a median age of 53 (range:19-87). The majority (89.6%) received systemic chemotherapy prior to pump placement. Evidence of EHD was present in 62.6% of patients, with lymph node (38.9%) and lung (35.7%) being the most common sites of disease. Of these patients, lesions were suspicious in 28.6%. Patients with EHD were more likely to have larger CRLM (median 3.9 vs 3.4 cm, p=0.039), compared to patients without EHD. Other characteristics including gender, stage, grade, and lymphovascular invasion were not found to significantly differ between the groups (p=0.11-0.84). OS was worse for patients with EHD compared to those without EHD (median 2.0 vs 2.7 years, adj-p< 0.0001, Figure 1). Patients with single sites of EHD had longer survival compared to those with multiple sites (2.2 vs 1.8 vs 2.7 years for no EHD, adj-p< 0.01). Median OS for patients with lymph node only, lung only, and peritoneal only disease was 2.1 vs 2.2 vs 1.7 years, respectively. Patients with EHD were more likely to have hepatic progression compared to patients without EHD (1-year incidence 25.8% vs 14.3%, p< 0.001).
Conclusions:
Extrahepatic disease is associated with worse overall outcomes for patients with unresectable CRLM treated with HAI-SYS. Regardless of site, however, single-site EHD does not appear to be a contraindication to HAI-SYS.