40 | wetenschapsdag 2023 Sessie 1c: We Zullen Doorgaan x1 Auteurs M. Zeeuw, A. Bakker, N. J. Wesdorp, M. Ali, K. Voigt, M. Starmans, J. Roor, J.T.M. van Waesberghe, J. van den Bergh, I. Nota, S. Moos, S. van Dieren, J. Stoker, D. Grunhagen, R. Swijnenburg, C.J.A. Punt, J. Huiskens, C. Verhoef, G. Kazemier and the Dutch Colorectal Cancer Group Liver Expert Panel Abstract titel Total tumor volume assessment in patients with colorectal liver metastases: an alternate prognostic biomarker for recurrence Background Colorectal cancer metastasizes to the liver in more than half of the patients, and after local treatment of the liver approximately 80% experiences recurrence of disease. This study aims to assess the prognostic value of total tumor volume (TTV) for recurrence-free survival in patients with colorectal liver metastases (CRLM), treated with induction systemic therapy followed by local treatment. Methods Patients with liver-only CRLM from the multicenter randomized clinical trial CAIRO5 (NCT02162563) that received induction systemic therapy followed by local treatment were included. Baseline TTV and change in TTV as response to systemic therapy were calculated using the CT scan before and after systemic treatment. The prognostic value of TTV and other clinical variables were assessed using multivariable Cox regression analyses. Results In total, 430 contrast-enhanced abdominal CT-scans with 2400 CRLM in 215 patients were included with a median baseline TTV of 48.5 ml [17.1-178.0] and absolute change in TTV of -21.1 ml [-81.3 to -6.2]. Baseline TTV and absolute change in TTV together had significant additional prognostic value over conventional clinical variables (likelihood ratio test, P = 0.021). Using baseline TTV, absolute delta TTV, CEA, number of metastases, lobar distribution and timing of metastases , two risk groups are created that show a significant difference in 6-month recurrence-free survival probability (high-risk: 44% vs low-risk: 72%; hazard ratio: 2.33 [1.72 to 3.16]; P < 0.0001). Conclusion TTV demonstrates independent prognostic value for recurrencefree survival and enhances the predictive accuracy of a Cox regression model that incorporates established prognostic factors. Further validation is warranted, but the incorporation of TTV into established prognostic models for patients with initially non-locally treatable CRLM has the potential to enhance risk stratification and facilitate personalized clinical decision-making.
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