Survival Outcomes and Recurrence Patterns in Resectable Colorectal Liver Metastases: Induction Systemic Therapy Versus Upfront Local Treatment

Survival Outcomes and Recurrence Patterns in Resectable Colorectal Liver Metastases: Induction Systemic Therapy Versus Upfront Local Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Survival Outcomes and Recurrence Patterns in Resectable Colorectal Liver Metastases: Induction Systemic Therapy Versus Upfront Local Treatment Preeyapon Senavat, Nuttinee Inworn, Nuttapong Ngamphaiboon, Teerada Siripoon, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7431317/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hepatic resection is the only curative treatment for colorectal liver metastases (CRLM), but most patients recur. Neoadjuvant chemotherapy (NAC) is increasingly used for resectable CRLM, though its benefit remains uncertain. This study compared induction systemic therapy and upfront local treatment (LT) in patients with resectable CRLM. Methods Patients were retrospectively identified from a cancer-registered CRLM database. Only those who underwent curative-intent LT between January 2012 and December 2018 were included. Results A total of 161 patients were analyzed: 95 in the NAC group (59%) and 66 in the LT group (41%). Median follow-up was 48 months. Recurrence occurred in 119 patients (74.38%): 75 in NAC and 44 in LT (74.99% vs. 66.67%; p = 0.062). Intrahepatic recurrence was most common (41.25%) and more frequent after NAC (47.37% vs. 31.82%; p = 0.048). Five-year overall survival (OS) was 44.36% (median 53.42 months), with no group difference (46.70% vs. 41.03%; p = 0.462). Five-year progression-free survival (PFS) was 29.23% (median 22.98 months), also with no difference (31.83% vs. 26.41%; p = 0.883). In low-risk patients, NAC improved 5-year PFS (47.01% vs. 36.20%; p = 0.01), whereas no benefit was observed in high-risk patients (20.09% vs. 17.14%; p = 0.30). All recurrence was associated with worse survival, but survival did not differ by recurrence type. Conclusions Induction systemic therapy improved PFS in low-risk patients but had no effect on OS. Recurrence patterns were comparable between NAC and upfront LT. recurrence pattern induction chemotherapy upfront local treatment resectable colorectal liver metastases survival Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7431317","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":524993171,"identity":"613a20d3-3524-482d-904a-017b87a3211d","order_by":0,"name":"Preeyapon Senavat","email":"","orcid":"","institution":"Faculty of Medicine, Ramathibodi Hospital, Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Preeyapon","middleName":"","lastName":"Senavat","suffix":""},{"id":524993172,"identity":"86ddc0b6-1aee-44e6-bb23-ebb2f8a5b625","order_by":1,"name":"Nuttinee Inworn","email":"","orcid":"","institution":"Faculty of Medicine, 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07:40:30","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":716050,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptResectableCRLM.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7431317/v1_covered_5cca9fd1-c577-4af3-ad59-b4527a3d52d7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Survival Outcomes and Recurrence Patterns in Resectable Colorectal Liver Metastases: Induction Systemic Therapy Versus Upfront Local Treatment","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"recurrence pattern, induction chemotherapy, upfront local treatment, resectable colorectal liver metastases, survival","lastPublishedDoi":"10.21203/rs.3.rs-7431317/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7431317/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHepatic resection is the only curative treatment for colorectal liver metastases (CRLM), but most patients recur.\u003cstrong\u003e \u003c/strong\u003eNeoadjuvant chemotherapy (NAC) is increasingly used for resectable CRLM, though its benefit remains uncertain. This study compared induction systemic therapy and upfront local treatment (LT) in patients with resectable CRLM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were retrospectively identified from a cancer-registered CRLM database. Only those who underwent curative-intent LT between January 2012 and December 2018 were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 161 patients were analyzed: 95 in the NAC group (59%) and 66 in the LT group (41%). Median follow-up was 48 months. Recurrence occurred in 119 patients (74.38%): 75 in NAC and 44 in LT (74.99% vs. 66.67%; \u003cem\u003ep\u003c/em\u003e = 0.062). Intrahepatic recurrence was most common (41.25%) and more frequent after NAC (47.37% vs. 31.82%; \u003cem\u003ep\u003c/em\u003e = 0.048). Five-year overall survival (OS) was 44.36% (median 53.42 months), with no group difference (46.70% vs. 41.03%; \u003cem\u003ep\u003c/em\u003e = 0.462). Five-year progression-free survival (PFS) was 29.23% (median 22.98 months), also with no difference (31.83% vs. 26.41%; \u003cem\u003ep\u003c/em\u003e = 0.883). In low-risk patients, NAC improved 5-year PFS (47.01% vs. 36.20%; \u003cem\u003ep\u003c/em\u003e = 0.01), whereas no benefit was observed in high-risk patients (20.09% vs. 17.14%; \u003cem\u003ep\u003c/em\u003e = 0.30). All recurrence was associated with worse survival, but survival did not differ by recurrence type.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInduction systemic therapy improved PFS in low-risk patients but had no effect on OS. Recurrence patterns were comparable between NAC and upfront LT.\u003c/p\u003e","manuscriptTitle":"Survival Outcomes and Recurrence Patterns in Resectable Colorectal Liver Metastases: Induction Systemic Therapy Versus Upfront Local Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 19:02:04","doi":"10.21203/rs.3.rs-7431317/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"08d4c2fd-9912-4fb3-9d3d-d4d28bc2c485","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-18T13:23:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 19:02:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7431317","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7431317","identity":"rs-7431317","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}