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Comment & Response
October 13, 2021

No Strong Evidence on Liver Transplant for Colorectal Cancer Liver Metastasis Over Portal Vein Embolization Associated With Liver Resection—Reply

Author Affiliations
  • 1Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
  • 2Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
  • 3Department of Hepatobiliary Surgery, Oslo University Hospital, Oslo, Norway
  • 4Institute of Clinical Medicine, University of Oslo, Oslo, Norway
JAMA Surg. 2022;157(2):173-174. doi:10.1001/jamasurg.2021.5127

In Reply We would like to thank Aini et al for commenting on our article on liver transplant (LT) in colorectal cancer liver metastases.1 Our results were presented as Kaplan-Maier–estimated overall survival (OS) because not all patients were observed for 5 years or until death. According to Aini et al, patients receiving portal vein embolization (PVE) and liver resection (LR) had a 5-year OS of 54.8% compared with 50.0% in patients receiving LT, which lead Aini et al to conclude that LT does not result in better OS than PVE-LR. For the PVE-LR and LT groups, patients with low tumor load had significantly better OS than patients with high tumor load. As reported in the PVE-LR group, 5-year OS was 69.3% (n = 23) and 12.5% (n = 8) in the groups with low tumor load vs high tumor load, respectively. In the LT group, the results were 72.4% and 33.4% for the groups with low tumor load vs high tumor load, respectively. In the PVE-LR (high tumor load and low tumor load) cohorts, 8 of 31 patients (25.8%) had high tumor load. In contrast, in the LT group, 29 of 50 patients (58.0%) were in the high tumor load category. This critical difference in the tumor load is not taken into account when Aini et al did the calculations, and their statement is therefore misleading.

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