The Pathologic Complete Response Ratio of Liver Metastases Represents a Valuable Prognostic Indicator

Background and Objectives: The aim of this study was to evaluate the role of the pathologic complete response ratio of liver metastases (PCRRLM) in predicting the prognosis and recurrence of colorectal cancer liver metastases (CRLM).Methods: A total of 305 CRLM patients who underwent preoperative chemotherapy followed by hepatectomy were included. PCRRLM was defined as the number of liver metastases exhibiting pathologic complete response (PCR) divided by the number of total resected liver metastases. The Kaplan-Meier method was used to calculate survival, and differences were examined by the log-rank test. Univariate and multivariate analyses were performed to identify the predictors of PCRRLM, recurrence-free survival (RFS) and overall survival (OS).Results: Among the 305 included patients, 44 (14.4%) achieved a PCRRLM >= 0.50 (including PCRRLM = 1), and 261 (85.6%) achieved a PCRRLM <0.50 (including PCRRLM = 0). Patients of an older age (>= 55 years old) and those with higher carcinoembryonic antigen (CEA) levels (>= 5 ng/ml) were less likely to achieve a PCRRLM >= 0.50. In the multivariate analysis, PCRRLM >= 0.50 (vs. < 0.50, HR [95% CI]: 0.67 [0.46-0.99], p = 0.043) was associated with better RFS. Positive lymph node status (vs. negative, HR [95% CI]: 1.46 [1.04-2.05], p = 0.028) and TBS >= 5 (vs. < 5, HR [95% CI]: 1.44 [1.02-2.04], p = 0.038) were associated with worse RFS.Conclusion: PCRRLM was significantly associated with long-term RFS after preoperative chemotherapy and CRLM resection. Thus, it may be a valuable indicator of recurrence in CRLM patients.