Histopathologic patterns as markers of prognosis in patients undergoing hepatectomy for colorectal cancer liver metastases

Trabalho final de mestrado integrado em Medicina área científica de Cirurgia Geral, apresentado á Faculdade de Medicina da Universidade de Coimbra ; Introduction: Liver resection combined with neoadjuvant chemotherapy (NAC) has reported notable results in patients with colorectal liver metastases (CRLM). Tumoral response to NAC is associated with specific histopathologic patterns with prognostic implications. The primary objective of this study was to evaluate the influence of pathological findings on overall survival (OS), disease-free survival (DFS) and liver recurrence-free survival (LRFS) and secondarily to analyze the role of NAC and clinical features on patients’ outcome. Patients and Methods: Analysis of clinical and outcome data from 110 patients who underwent first CRLM resection between January 2010 and July 2013 was carried out. Blinded pathological review of histological material of several parameters: resection margin, tumor regression grade (TRG), tumor thickness at the tumor-normal interface (TTNI) and the growth pattern (GP). Results: The median survival following hepatic resection was 52 months and 3- and 5- year Kaplan-Meier estimates were 69 and 48%, respectively. Seventy-four patients developed recurrent disease. Oxaliplatin-based chemotherapy was significantly associated with a pushing GP. A positive resection margin was an independent predictor of decreased DFS (p=0.018) and LRFS was strongly reduced by the absence of histologic tumor response (p=0.018). The pushing pattern had an adverse impact on both OS (p=0.007) and DFS (p=0.004) on multivariate analysis. Conclusion: The prognostic value of histopathological features in patients who underwent CRLM’s resection is undeniable. The pushing GP was related with worse prognosis. Further studies are required to clarify the biological mechanisms underlying these findings in order to enhance a more personalized and efficient treatment for these patients ; Introdução: A resseção hepática em associação com a quimioterapia neoadjuvante (QNA) tem ...