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Hepatectomy versus systemic therapy for liver-limited BRAF V600E-mutated colorectal liver metastases: multicentre retrospective study.

Hepatectomy versus systemic therapy for liver-limited BRAF V600E-mutated colorectal liver metastases: multicentre retrospective study. The British journal of surgery Margonis, G. A., Wang, J. J., Boerner, T., Moretto, R., Buettner, S., Andreatos, N., Gagniere, J., Wagner, D., Loes, I. M., Bergamo, F., Pietrantonio, F., Scartozzi, M., Spallanzani, A., Vincenzi, B., Antoniou, E., Pikoulis, E., Sartore-Bianchi, A., Stasinos, G., Sasaki, K., Pawlik, T. M., Orlandi, A., Pella, N., Fitschek, F., Kaczirek, K., Dupre, A., Pozios, I., Beyer, K., Kornprat, P., Aucejo, F. N., Burkhart, R., Weiss, M. J., Lonning, P. E., Poultsides, G., Cremolini, C., Kreis, M. E., D'Angelica, M. 2024; 111 (7)

Abstract

BACKGROUND: To date, only two studies have compared the outcomes of patients with liver-limited BRAF V600E-mutated colorectal liver metastases (CRLMs) managed with resection versus systemic therapy alone, and these have reported contradictory findings.METHODS: In this observational, international, multicentre study, patients with liver-limited BRAF V600E-mutated CRLMs treated with resection or systemic therapy alone were identified from institutional databases. Patterns of recurrence/progression and overall survival were compared using multivariable analyses of the entire cohort and a propensity score-matched cohort.RESULTS: Of 170 patients included, 119 underwent hepatectomy and 51 received systemic treatment. Surgically treated patients had a more favourable pattern of recurrence with most recurrences limited to a single site, whereas diffuse progression was more common among patients who received systemic treatment (19 versus 44%; P = 0.002). Surgically treated patients had longer median overall survival (35 versus 20 months; P < 0.001). Hepatectomy was independently associated with better OS than systemic treatment alone (HR 0.37, 95% c.i. 0.21 to 0.65). In the propensity score-matched cohort, surgically treated patients had longer median overall survival (28 versus 20 months; P < 0.001); hepatectomy was independently associated with better overall survival (HR 0.47, 0.25 to 0.88).CONCLUSION: BRAF V600E mutation should not be considered a contraindication to surgery for patients with resectable, liver-only CRLMs.

View details for DOI 10.1093/bjs/znae176

View details for PubMedID 39051667