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

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.