The survival benefit of neoadjuvant chemotherapy for resectable colorectal liver metastases with high tumor burden score
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ORIGINAL ARTICLE
The survival benefit of neoadjuvant chemotherapy for resectable colorectal liver metastases with high tumor burden score Yoshihiko Yonekawa1 · Kay Uehara1 · Takashi Mizuno1 · Toshisada Aiba1 · Atsushi Ogura1 · Toshiki Mukai1 · Yukihiro Yokoyama1 · Tomoki Ebata1 · Yasuhiro Kodera2 · Masato Nagino1 Received: 25 March 2020 / Accepted: 22 September 2020 © Japan Society of Clinical Oncology 2020
Abstract Background The indications for neoadjuvant chemotherapy (NAC) in resectable colorectal liver metastases (CRLMs) remain unclear. Tumor burden score (TBS) is a prognostic tool based on tumor size and number of tumors. However, its utility in the NAC setting for initially resectable CRLM has never been investigated. Methods TBS is a distance from the origin on a Cartesian plane to the coordinates (x, y) = (tumor size in centimeter, number of tumors). TBS 200 ng/ mL, largest liver metastasis > 5 cm, and lymph node-positive primary tumor are counted as 1 point each, and a score of more than 2 points is considered high risk. Importantly, this clinical risk score was developed in only patients who underwent upfront surgery. In fact, the prognostic accuracy of risk scores has not always been reproducible by external cohort
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validation in the era of currently developed chemotherapy [19]. The tumor burden score (TBS), reported by Sasaki et al., is a newly developed model that translates the size and number of CRLMs into one variable using the Pythagorean theorem and has better prognostic discriminatory power than traditional tumor morphologic categorization [20]. The concept of the TBS was described as “Metro-ticket” paradigm; as the longer trip on the Metro results in higher cost, increments in size and number of CRLMs result in worse prognosis. Specifically, the hazard ratio (HR) for the OS of TBS ≥ 3 to
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