Colorectal cancer frequently metastasizes to the liver, rendering surgical removal of liver tumours infeasible for some patients. A new study led by the Wilmot Cancer Institute and the University of Rochester Medical Center (URMC) has found that a select group of patients with metastatic colorectal cancer to the liver may benefit more from liver transplantation than from other standard therapies. Published in JAMA Surgery, the study highlights that patients who underwent liver transplants tended to enjoy more extended periods of cancer progression-free survival compared to those who opted for alternative treatments.
The significance of this study lies in its comparison of liver transplantation to other treatment options, which is the first in the field. Matthew Byrne, MD, a surgical resident at URMC and author of the study, emphasized the importance of comparing outcomes between patients who received the intervention and those who did not. He noted, “Without randomized, controlled trial data, this study offers the best evidence that is available to understand whether liver transplant provides better outcomes over other treatments.” The study was led by Roberto Hernandez-Alejandro, MD, chief of Abdominal Transplant and Liver Surgery at URMC, and it followed 33 patients whose colorectal cancer was under control but who had liver tumours that could not be surgically removed.
Of these patients, 20 chose to undergo liver transplantation, while the remaining 13 opted for classical therapies such as liver resection, chemotherapy, or liver-directed therapies. The results were striking: one year after transplantation, 90% of transplant patients showed no signs of cancer progression. This rate declined to 73% after two years and 36% after three years. In contrast, only 42% of patients undergoing conventional treatments were free of cancer progression after one year, with this figure falling to around 10% after two and three years.
The study also found that the liver transplant group had higher overall survival rates than the standard therapy group, though the difference was not statistically significant. Three years post-transplant, 90% of transplant patients were still alive, compared to 73% of those who received other treatments. Despite these encouraging findings, the research underscores the need for more extensive clinical trials to fully understand the benefits of liver transplantation over other therapies for these patients and to determine better which patients are most likely to benefit.
Hernandez-Alejandro pointed out the limitations of liver transplantation, noting that it is not suitable for every patient with advanced metastatic disease in the liver. The success of such treatments depends on stringent criteria based on tumour biology, the behaviour of the tumours, and how well they respond to chemotherapy. Only patients likely to have a good outcome are considered for transplantation. URMC has established itself as a leader in living-donor liver transplants, which are critical given the scarcity of livers from deceased donors. Of the 20 liver transplant patients in the study, 17 received liver tissue from living donors.
As of July 2024, URMC’s liver transplant program has conducted more living-donor liver transplants for patients with colorectal liver metastases than any other centre in North America, totalling 24. “Right now, URMC is the largest centre in the country and the second largest in the world, doing liver transplant for colorectal liver metastases,” Hernandez-Alejandro stated, emphasizing the institution’s pioneering role in the field and its efforts to expand the living-donor liver transplant program. This study contributes to the existing literature on the benefits of liver transplantation and sets the stage for future research and treatment protocols that could potentially save more lives.
More information: Matthew M. Byrne et al, Progression-Free Survival for Liver Transplant vs Alternative Therapy in Unresectable Colorectal Liver Metastasis, JAMA Surgery. DOI: 10.1001/jamasurg.2024.2057
Journal information: JAMA Surgery Provided by University of Rochester Medical Center
