Benefits Of Multi-Disciplinary Treatment Strategy On Survival Of Patients With Colorectal Cancer Liver Metastasis

Dear editor: More than 25% of colorectal cancer (CRC) have liver metastasis (CRLM),1 for which the multi-disciplinary treatment (MDT) has emerged as an alternative of therapeutic strategies in China.2 In the present study, we reported a long-term MDT treatment experiences and assessed the advantages of the MDT strategy, and furthermore, we also aimed to define the criteria of the suitable CRLM patients who can be benefited more from MDT strategy. This study retrospectively enrolled two independent cohorts of consecutive CRLM patients (MDT cohort and No-MDT cohort). Management of MDT and statistical methods are described in Supporting Information Section 1. From February 9, 2009 to December 28, 2017, a total of 3740 consecutive MDT discussions were studied, and MDT times are shown in Figure S1. The management workflow of two independent cohort is shown in Figure 1A. A total of 1027 CRLM patients received MDT and 401 CRLMpatients were treatedwithoutMDT. Of 1027 MDT patients, 51% were males and 54% were older than 60 years. The majority of MDT cohort patients with CRLM had more liver metastatic lesions (P < .01) and shorter tumor size (P < .01). More advanced CRLM received MDT (Table S1). Figure S2 demonstrates the compliance rate of surgical and no-surgical plan in MDT and No-MDT cohorts. Univariate and multivariate logistics analysis for compliance to treatment suggestion are performed in Table S2, and MDT was regarded as an independent factor for adherence (P < .01). Reasons for changes to treatment plan are shown in Table S3. In addition, thoracic CT scan, CA125/CA724 and pelvic MRI scan, liver MRI scan, RAS/RAFmutation status, and PET/CT of CRLM patients in MDT cohort showed significant difference from NoMDT controls (Table S4; P < .01). Of 1027 patients in MDT cohort, 264 patients had extra-hepatic metastasis (25.7%), including 212 lung (21%), 43 bone (4%), and 54 transcelomic metastases (5%). Resectability change in 202 patients (20%) and additional targeted therapies were added in selective 307 patients (30%) (Table S5).