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Management of colorectal cancer patients after resection of liver metastases: can we offer a tailored treatment? | LitMetric

AI Article Synopsis

  • - Surgical resection is the primary cure for colorectal liver metastases, and all patients should be considered for surgery despite differing opinions on pre- and post-operative treatment strategies.
  • - Various prognostic factors have been linked to worse outcomes after surgery, including high C-reactive protein, neutrophil-lymphocyte ratio, and elevated levels of CEA and Ki 67.
  • - Preoperative chemotherapy can improve prognosis, and assessing specific genetic factors prior to chemotherapy can help minimize side effects and enhance the patients' quality of life.

Article Abstract

Surgical resection remains the only option of cure for patients with colorectal liver metastases, and no patient should be precluded from surgery. There is much controversy not only regarding the most appropriate therapeutic approach in the neoadjuvant setting but also after surgery is performed. Many patients will experience early relapses but others will be long survivors. We need to establish reliable prognostic and predictive factors to offer a tailored treatment. Several prognostic factors after metastasectomy have been identified: high C-reactive protein levels, a high neutrophil-lymphocyte ratio, elevated neutrophil count and low serum albumin are related to a worst outcome. Elevated CEA and Ki 67 levels, intrahepatic and perihepatic lymph node invasion are also some of the markers related to a worst outcome. In contrast, the administration of preoperative chemotherapy has been associated with a better prognosis after hepatectomy. The administration of adjuvant chemotherapy should be done taking in consideration these factors. Regarding predictive factors, determination of ERCC1, TS, TP and DPD and UGT1 polymorphisms assessment could be considered prior to chemotherapy administration. This would avoid treatment related toxicities and increase this population quality of life.

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Source
http://dx.doi.org/10.1007/s12094-012-0853-8DOI Listing

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