Evaluación de la respuesta de las metástasis hepáticas de cáncer de colon o recto al tratamiento quimioterápico neoadyuvante

Résumé

Introduction: The evolution of neoadjuvant chemotherapy for the treatment of patients with liver metastases from colon or rectal cancer has evolved in the last 15 years. With the advent of immunotherapy, doubts arise about which is the ideal radiological response analysis method. It is also important to determine whether the changes that occur within metastases secondary to neoadjuvant treatment have an impact on patient survival. Patients and method: We carried out a retrospective study of patients operated on for liver metastases due to colon or rectal cancer who had received neoadjuvant chemotherapy treatment at the Marqués de Valdecilla University Hospital, during the period between January 2000 and December 2017. The radiological response of these patients based on the three proposed analysis methods, namely: RECIST 1.1, mRECIST and EASL. Histological samples were analyzed after metastasectomy, classifying the patients according to the degree of tumor regression, based on the criteria proposed by Dr. Rubbia-Brandt. The relationship between the different radiological analysis methods and the histological response was determined using the Chi square test and the Goodman and Kruskal gamma (γ). A multivariate analysis was performed to analyze survival as a function of radiological and histological response using the Cox regression model. Results: The γ shows a significant relationship between the three radiological response methods and the histological response, although this association is stronger when compared with the RECIST 1.1 method (γ = 0.4921, p <0.001). Survival analysis based on histological response shows higher survival for those patients who respond to chemotherapy (p <0.001). The multivariate analysis determines that the RECIST 1.1 method for the analysis of the radiological response is an independent prognostic factor (p = 0.019). Although statistical significance is not reached for the degree of tumor regression, an increasing Hazard ratio is observed as the response to neoadjuvant treatment decreases. Conclusions: The degree of tumor regression proposed by Dr. Rubbia-Brandt correlates with patient survival. The RECIST 1.1 criteria are the ideal radiological analysis method for the study of liver metastases from colon or rectal cancer treated with neoadjuvant chemotherapy. There is a statistically significant correlation between radiological response and histological response, which allows predicting the evolution of patients treated with neoadjuvant chemotherapy.