RT Journal Article
SR Electronic
T1 Prognostication with metabolic and pathological response to preoperative chemotherapy in colorectal liver metastases
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1358
OP 1358
VO 55
IS supplement 1
A1 Lau, Lawrence
A1 Williams, David
A1 Scott, Andrew
A1 Christophi, Chris
A1 Muralidharan, Vijayaragavan
A1 Lee, Sze Ting
YR 2014
UL http://jnm.snmjournals.org/content/55/supplement_1/1358.abstract
AB 1358 Learning Objectives Prognostic value of metabolic and pathological response in patients with colorectal liver metastases treated with preoperative chemotherapy. Background: The response of colorectal cancer liver metastases (CRCLM) to preoperative chemotherapy is a major determinant of patient outcome. Methods: 37 patients with 18F-FDG PET pre- and post-preoperative chemotherapy for CRCLM between 2004-2011 were included. Metabolic response was determined as change in SUVmax. Resected specimens were scored according to tumor regression grading (TRG), with significant (TRG 1 or 2) or insignificant pathological response (TRG 3-5). Prognostic indicators of RECIST response & clinicopathological scores were assessed. Correlation to recurrence-free (RFS) and overall survival (OS) was assessed using Kaplan-Meier survival and multivariate analysis. Results: Complete and partial metabolic response was observed in 24% and 50%, whilst stable and progressive metabolic disease was seen in 13%. Patients with metabolically responsive tumors had OS of 86% at 3 years vs. 38% with metabolically progressive tumors (p=0.003). Significant tumor regression was noted in 19% while insignificant tumor regression noted in 81% of patients. Patients with significant tumor regression had an OS of 100% at 3 years vs 72% in those with insignificant tumor regression (p=0.066). RECIST criteria did not predict outcome. On multivariate analysis, only metabolic response and the Fong prognostic score predicted OS while only metabolic response was predictive of RFS. Conclusion: Preoperative metabolic and pathological response both predict prognosis. Metabolic response strongly correlated to OS and RFS while major pathological response was highly specific (100%) for OS, but not RFS. Assessing tumor response to preoperative chemotherapy indicates systemic control of metastatic colorectal cancer and prognosis post-liver metastectomy.