P31. Long-term outcomes of adjuvant hepatic arterial infusion chemotherapy after resection of hepatic metastases from colorectal cancer: a secondary analysis of a phase III trial

Thursday, March 5, 2026

11:14 AM - 11:21 AM MST

Location: 301D

Co-Author(s)

HK

Hannah Kalvin, MSPH

Research Biostatistician
Memorial Sloan Kettering Cancer Center
New York, New York, United States
AC

Andrea Cercek, MD

Attending
MEMORIAL SLOAN KETTERING CANCER CENTER
New York, New York, United States
LC

Louise C. Connell, MB BCh BAO

Attending
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Lily V. Saadat, MD

Assistant Attending Surgeon
MEMORIAL SLOAN KETTERING CANCER CENTER
New York, New York, United States
Vinod Balachandran, MD

Assistant Attending Surgeon
MEMORIAL SLOAN KETTERING CANCER CENTER
New York, New York, United States
JD

Jeffrey A. Drebin, MD, PhD

Chair of Surgery
MEMORIAL SLOAN KETTERING CANCER CENTER
New York, New York, United States
TK

T. Peter Kingham, MD

Professor
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Alice C. Wei, MD (she/her/hers)

Attending Surgeon
MEMORIAL SLOAN KETTERING CANCER CENTER
New York, New York, United States
KS

Kevin C. Soares, MD

Assistant Attending Surgeon
MEMORIAL SLOAN KETTERING CANCER CENTER
New York, New York, United States
William R. Jarnagin, MD

Chief of Hepatopancreatobiliary Surgery
MEMORIAL SLOAN KETTERING CANCER CENTER
New York, New York, United States
MG

Mithat Gonen, PhD

Chief of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center
New York, New York, United States
NK

Nancy E. Kemeny, MD

Attending
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Michael I. D’Angelica, MD

Enid A. Haupt Endowed Chair in Surgery, Professor
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Primary Presenter(s)

Remo Alessandris, MD

Research Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Introduction: Multiple randomized trials have demonstrated that perioperative systemic chemotherapy following resection of colorectal liver metastasis (CRLM) does not improve overall survival (OS). Hepatic arterial infusion (HAI) plus systemic chemotherapy has been shown as the only adjuvant therapy to significantly improve 2-year OS in a randomized trial.

Methods: This is a secondary analysis of a single-institution, phase III trial that enrolled 156 patients with resected CRLM between 1991–1998, with follow-up updated as of February 7, 2025. The primary aim was to assess long-term oncologic outcomes (hepatic recurrence, recurrence at any site, disease specific survival), estimated using cumulative incidence functions to account for competing risks (death without hepatic recurrence, death from other/unknown causes). Comparisons were made using Gray’s test. Overall survival was estimated using Kaplan-Meier (KM) and median follow-up via reverse KM.

Results:

A total of 156 patients were treated on trial and randomized to receive adjuvant HAI with floxuridine plus systemic fluorouracil (n=74) or systemic fluorouracil alone (n=82). The median follow-up was 26 years (95% CI: 19-29) for the entire cohort. The cumulative incidence of hepatic recurrence at 5 and 10 years was 27% (95% CI: 17–38) and 30% (95% CI: 20–41) in the HAI group, versus 52% (95% CI: 40–62) and 53% (95% CI: 41–64) in the systemic group (p=0.002). The cumulative incidence of recurrence (any site) at 5 and 10 years was 58% (95% CI: 46–68) and 62% (95% CI: 50–72) in the HAI group, versus 63% (95% CI: 52–73) and 70% (95% CI: 58–78) in the systemic group (p=0.2). Median OS was 5.7 years (95% CI: 4.4-12) in the HAI group and 4.9 years (95% CI: 3.5-7.1) in the systemic therapy. The cumulative incidence of disease-specific death at 5, 10, and 15 years was 39% (95% CI: 28–50), 55% (95% CI: 43–66), and 55% (95% CI: 43–66) in the HAI group, versus 50% (95% CI: 39–60), 63% (95% CI: 52–73), and 66% (95% CI: 55–76) in the systemic group (p=0.14).

Conclusions: Adjuvant HAI in combination with systemic chemotherapy offer long-term durable hepatic disease control after resection of CRLM. Although differences in disease-specific death were not statistically significant, this was an underpowered study for long-term survival outcomes; nevertheless, the effect size and direction of the association support a potential oncologic benefit and justify renewed investigation of HAI in contemporary randomized trials.

Learning Objectives:

To describe the long-term oncologic outcomes of adjuvant hepatic arterial infusion chemotherapy following resection of colorectal liver metastases, including its impact on hepatic recurrence and disease-specific survival.
To interpret why the authors used the cumulative incidence functions with competing risks analysis rather than traditional Kaplan-Meier methods, and how does this methodology strengthen the validity of their conclusions.