Is recurrence-free survival an appropriate endpoint in the study of liver metastasis from colorectal cancer?

In adjuvant trials of adjuvant therapy in patients after resection of liver metastases from colorectal cancer, recurrence-free survival (RFS) was used as a proxy for overall survival (OS) in order to interpret treatment outcomes
earlier.
However, in the context of the above diseases, the association between RFS and OS has not been verified
.

In a 30-year retrospective, single-institution study in which they evaluated the association
between RFS and OS in 2,983 patients who underwent radical hepatectomy for colorectal cancer liver metastases.
Nearly half of patients (46%) had a left-sided colonic primary, 62% had a node-positive primary, and most patients (63%) had one or both liver metastases resected (56%)
.
R0 resection was achieved in 88% of patients, 91% received other systemic therapies, and 28% received hepatic arterial perfusion chemotherapy
as part of adjuvant therapy.

During a median follow-up of 8.
4 years, disease relapse occurred in 67% of patients, with a median RFS of 1.
3 years and a median OS of 5.
2 years
.
The correlation between RFS and OS is small
.
Between patients in the early assessment (1991-2000) and the later evaluation (2001-2019), the RFS was similar, but the OS of the patients in the later evaluation was longer
.

The authors also evaluated the association between RFS and OS in a meta-analysis of phase 3 adjuvant therapy trials involving a total of 1,185 colorectal cancer patients
undergoing hepatectomy.
There is no correlation
between RFS and OS.

In adjuvant therapy trials in patients after liver metastasis resection for colorectal cancer, RFS was not used as a surrogate indicator
of OS.
In these cases, OS should be the benchmark
for judging the effectiveness of treatment.

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