Surgery News - August 2007 - (Page 5)

AUGUST 2007 • SURGERY NEWS ONCOLOGY 5 Liver Resection May Help Patients With SCC Metastases B Y A L I C I A A U LT Else vier Global Medical Ne ws WA S H I N G T O N — Select patients may benefit from hepatic resection for liver metastases from a primary squamous cell carcinoma, Dr. Timothy Pawlik said at a symposium sponsored by the Society of Surgical Oncology. The liver is the metastatic site for squamous cell carcinoma (SCC) of the head and neck, esophagus, and lung. About 20% of patients with anal SCC also develop distant metastases, most frequently in the liver, said Dr. Pawlik, who presented the data on behalf of his colleagues at multiple U.S. clinical centers. Hepatic resection as a strategy for SCC is not well defined, said Dr. Pawlik of Johns Hopkins University, Baltimore. The goal of the study was to evaluate the efficacy of surgery and to identify the clinical and pathologic factors associated with disease-free and overall survival, he said. The researchers also aimed to identify patterns of recurrence. Through structured queries of staff from eight hepatobiliary centers in the United States and Europe, the researchers identified 52 patients who underwent curative resection of metastatic SCC from 1988 to 2006. The median patient age was 55, and most patients—60%—were female. A total of 27 patients (52%) had a primary anal SCC; 25 (48%) had a nonanal primary SCC tumor site, most of which were in the head and neck. Most patients presented with a T3 or T4 primary lesion and had positive lymph nodes associated with the lesion. Because SCC tumor biology may differ based on the primary anatomic site, the investigators decided to compare anal and nonanal tumors. They found no difference between the two groups in terms of the extent of metastatic disease, median tumor number, or size or location of the lesion. Most patients with primary anal SCC were treated with chemotherapy and radiotherapy. Patients with nonanal primary tumors were more likely to be treated with chemo, radiotherapy, and surgery. Overall, less than 20% of patients received surgery alone for a primary lesion. For hepatic metastases, resection alone was the overwhelming procedure of choice in both anal and nonanal patient cohorts. Surgery alone was elected by 24 anal tumor patients and 23 nonanal patients, said Dr. Pawlik. A minority of patients underwent radiofrequency ablation, either alone or in combination with hepatic resection. After undergoing resection, 60% of patients also had adjuvant chemotherapy. Microscopically positive margins were seen in 5 patients (19%) in the primary anal SCC group and in 2 patients (8%) in the nonanal group. The difference was not statistically significant, said Dr. Pawlik. Of the 52 patients who had surgery for hepatic metastases, 33 (63%) had a recurrence: 12 in the liver only, 11 in a distant site only, and 10 in both the liver and a distant site. The overall pattern of recurrence was similar for all patients. Patients with a primary anal SCC had a slightly increased likelihood of recurrence in the liver and at an extrahepatic site. The median disease-free survival was 10 months for all patients, and the 3-year disease-free survival rate was 18%. There was no difference in disease-free survival between the anal and nonanal SCC patients. Hepatic metastases, tumor size greater than 5 cm, and a positive surgical margin were associated with worse disease-free survival. The median overall survival was 23 months, and the 5-year actuarial survival was 20% for all patients. Dr. Pawlik and his colleagues formulated a clinical risk score to better stratify resection patients for prognostic purposes: 0 (for no risk factors), 1 (for 1 risk factor), and 2 (for 2-3 risk factors). Risk factors included synchronous disease, hepatic metastasis greater than 5 cm, and positive surgical margins. Median survival times were 33 months for patients with a score of 0, 22 months for a 1, and 7 months for a 2. Patients with a score of 2 had an 80% increased hazard of death, versus those who had a score of 0. In patients who had three clinical risk factors, there were no survivors at 2 years. Dr. Pawlik concluded that most patients with either an anal or a nonanal primary SCC will have a recurrence after hepatic resection, and most will be at an extrahepatic site. For patients with limited metachronous disease that is resected with microscopically negative margins, the 5-year survival may approach 30% for either anal or nonanal primary tumors, said Dr. Pawlik. ■ http://www.tissuescience.com http://www.tissuescience.com http://www.tissuescience.com

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Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

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