colon Cancer often spreads to the liver, and surgical removal of liver tumors is not an option for some patients. A new study led by researchers at Wilmot Cancer Institute and the University of Rochester Medical Center (URMC) finds that some patients with colorectal cancer that has spread to the liver tend to fare better if they undergo a liver transplant than with other commonly used treatments.
In this study, Publication year JAMA SurgeryPatients who underwent liver transplants tended to survive longer without their cancer progressing than those who chose other treatments. Previous studies have shown benefits of liver transplants for these patients, but this is the first study to compare liver transplants with other treatments.
“With any cancer treatment, it's very easy to describe outcomes for patients who received the intervention, but similar patients who didn't get the intervention are a good comparison,” said Matthew Byrne, M.D., a surgery resident at URMC and author of the study. “While we don't have randomized controlled trial data, this study provides the best evidence available to understand whether liver transplantation results in better outcomes than other treatments.”
Because of the shortage of livers from cadaveric donors, 17 of the 20 liver transplant patients in the study received liver tissue from living donors.
URMC's liver transplant program has performed more living donor liver transplants for patients with colorectal cancer liver metastases than any other center in North America, totaling 24 as of July 2024.
“URMC is currently the largest center in the nation and the second largest in the world performing liver transplants for colorectal cancer liver metastases,” said Hernandez Alejandro, who led the recent effort to establish a living donor liver transplant program at URMC.
Learn more about our Liver Transplant Program.
The study, led by Roberto Hernandez-Alejandro, M.D., chief of the Department of Abdominal Transplant and Liver Surgery at URMC, followed 33 patients whose colon cancer was controlled but whose liver tumors could not be removed by surgery. All 33 patients were candidates for liver transplant, but only 20 opted for transplant, while 13 opted for other conventional treatments, including partial liver resection, chemotherapy, and liver-directed therapies.
The liver transplant group had a significantly higher progression-free survival rate over the three-year follow-up period compared with the conventional treatment group. One year after liver transplant, 90% of patients had no signs of cancer progression; that figure dropped to 73% after two years and 36% after three years. Meanwhile, only 42% of patients who chose other treatments had no signs of cancer progression after one year, dropping to about 10% after two and three years.
The transplant group also had a higher overall survival rate than the standard treatment group, but the difference was not statistically significant: At three years of follow-up, 90% of transplant patients survived, compared with 73% of patients who received other treatments.
Although this study provides solid evidence, larger clinical trials will be needed to fully understand the additional benefit of liver transplantation compared with other treatments for these patients and to more precisely determine which patients will benefit most.
“Unfortunately, liver transplantation is not an option for all patients with progressive metastatic disease in the liver,” says Hernandez Alejandro. “To get a good outcome and help these patients, we need to establish strict criteria based on the biology of the tumor, its behavior, and its response to chemotherapy. We only transplant patients who are likely to have a good outcome.”
