PATIENTS with unresectable colorectal liver metastasis (uCRLM) who underwent liver transplantation (LT) experienced significantly better outcomes compared to those who received alternative therapies, according to recent research. The study, led by Matthew Byrne, Rochester Medical Center, New York, USA, has provided valuable insights into the potential of LT in improving progression-free and overall survival in this challenging patient population.
The study involved 195 patients with uCRLM referred for LT evaluation at the University of Rochester between 2019 and 2023. Of these, 33 patients were deemed eligible for transplantation. Researchers compared the outcomes of 20 patients who opted for LT against 13 who declined LT and pursued other treatments, such as systemic chemotherapy, hepatic artery infusion, liver resection, or locoregional therapies like microwave and radiofrequency ablation.
Findings revealed that patients who underwent LT had markedly higher progression-free survival rates at 1 year (90% vs. 41.7%), 2 years (72.7% vs. 10.4%), and 3 years (36.4% vs. 10.4%) compared to those in the alternative therapy group. Overall survival was also superior in the LT group, with 100% survival at 1 year and 90% at 2 and 3 years, versus 83.9% and 73.4% in the alternative therapy group, respectively. Recurrence rates were also lower among LT patients, with only one patient (5%) experiencing recurrence, compared to three patients (23%) in the alternative therapy group.
Byrne and colleagues emphasised the importance of meticulous patient selection, adding that “patients with uCRLM should be referred for multidisciplinary evaluation to transplant oncology centers with strict LT criteria.” The team concluded their article by advocating for further studies to refine LT criteria and confirm its effectiveness for patients with uCRLM, calling for larger observational studies and randomised clinical trials to solidify LT as a standard treatment option in this context.
Victoria Antoniou, EMJ
Reference
Byrne MM et al. Progression-free survival for liver transplant vs alternative therapy in unresectable colorectal liver metastasis. JAMA Surg. 2024;DOI:10.1001/jamasurg.2024.2057.
