Liver transplant confers better long-term survival in select CRC patients

In the treatment of patients with nonresectable colorectal cancer (CRC) with liver metastases, liver transplantation may improve long-term survival outcomes especially when performed for those with favourable prognostic scoring, according to a study.

The study included 61 CRC patients (median age 57.8 years, 57.4 percent men) who underwent liver transplant. Of these, 60 patients had nonresectable metastases confined to the liver, while the remaining patient was deemed to have technically resectable disease. Post-transplant observation time ranged between 16 and 165 months, and none of the patients was lost to follow-up.

Median disease-free period for the cohort was 11.8 months (95 percent confidence interval [CI], 9.3–14.2). The median overall survival (OS) was 60.3 months (95 percent CI, 44.3–76.4), while the median survival after relapse was 37.1 months (95 percent CI, 4.6–69.5).

Factors that predicted lower OS were as follows: largest tumour size >5.5 cm (median OS, 25.3 months, 95 percent CI, 15.8–34.8; p<0.001), progressive disease while receiving chemotherapy (median OS, 39.8 months, 95 percent CI, 28.8–50.7; p=0.02), plasma carcinoembryonic antigen values >80 μg/L (median OS, 26.6 months, 95 percent CI, 22.7–30.6; p<0.001), liver metabolic tumour volume on positron emission tomography of >70 cm3 (median OS, 26.6 months, 95 percent CI, 11.8–41.5; p<0.001), primary tumour in the ascending colon (median OS, 17.9 months, 95 percent CI, 0–37.5; p<0.001), tumour burden score of 9 or higher (median OS, 23.3 months, 95 percent CI, 19.2–27.4; p=0.02), and ≥9 liver lesions (median OS, 42.5 months, 95 percent CI, 17.2–67.8; p=0.02).

Finally, liver transplant conveyed 10-year survival rates of 88.9 percent for patients with an Oslo score of 0 and 80.0 percent for patients with Fong Clinical Risk Score of 1.

The findings suggest the potential of liver transplant as a curative treatment option in patients otherwise offered only palliative care.