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Colorectal cancer often spreads to the liver, and for some patients, surgical removal of their liver tumors is not an option. A new study led by researchers at the Wilmot Cancer Institute and University of Rochester Medical Center (URMC) shows that a select group of patients with colorectal cancer that has spread to the liver tend to fare better if they receive a liver transplant as opposed to other common therapies.
In the study, published in JAMA Surgery, patients who had liver transplants tended to live longer without cancer progression than patients who opted for other treatments. While previous studies have shown the benefits of liver transplants for these patients, this is the first study to compare liver transplants to other treatment options.
“In any cancer treatment, it's very easy to describe the outcomes of the patients who received the intervention, but similar patients that did not undergo the intervention can serve as a good comparison,” said Matthew Byrne, MD, a surgery resident at URMC and author of the study. “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.”
Because livers from deceased donors are in short supply, 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 liver metastases than any other center in North America, 24 in total as of July 2024.
“Right now, URMC is the largest center in the country and the second largest center in the world, doing liver transplant for colorectal liver metastases,” said Hernandez-Alejandro, who led the recent effort to establish a living-donor liver transplant program at URMC.
The study, led by Roberto Hernandez-Alejandro, MD, chief of Abdominal Transplant and Liver Surgery at URMC, followed 33 patients whose colorectal cancer was under control, but who had liver tumors that could not be surgically removed. All 33 patients were eligible for liver transplantation, but only 20 chose to have a transplant, while 13 opted for other classical therapies, like removal of part of the liver, chemotherapy, or liver-directed therapies.
Compared to the classical therapy group, the liver transplant group had significantly higher progression-free survival rates across three years of follow-up. One year after liver transplant, 90 percent of patients showed no signs of cancer progression. That number dropped to 73 percent after two years and to 36 percent at three years. On the other hand, only 42 percent of patients who opted for other therapies were cancer-progression-free after one year, which dropped to roughly 10 percent after two and three years.
The transplant group also had higher overall survival rates than the standard therapy group, though the difference wasn’t statistically significant. At the three-year follow-up, 90 percent of transplant patients had survived, compared to 73 percent of patients who received other therapies.
Though this study provides solid evidence, larger clinical trials will be needed to fully understand the added benefit of liver transplant compared to other treatments for these patients—and to better refine which patients benefit most.
“Unfortunately, liver transplantation is not for every single patient who has advanced metastatic disease in the liver,” said Hernandez-Alejandro. “The way we can have good results and help these patients is by establishing strict criteria based on tumor biology, the behavior of these tumors, how well they respond to chemotherapy. We only perform transplants for patients who are likely to have a good outcome.”
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