Is mFOLFOX6 needed after hepatic metastases resection in colorectal cancer? Long-term JCOG0603 results
In January 2026, the Journal of Clinical Oncology published the long-term results of the Japanese randomized JCOG0603 trial. It compared hepatic metastases resection followed by mFOLFOX6 versus surgery alone in patients with colorectal cancer and liver-only metastases.
Key trial data
In the trial, 151 patients were randomized to surgery + mFOLFOX6 and 149 to surgery alone.
- 5-year relapse-free survival was 49.7% vs 40.5%
- 5-year overall survival was 73.4% with mFOLFOX6 vs 80.1% in the surgery-only group
- 7-year overall survival was 69.4% vs 72.4% respectively
- mFOLFOX6 reduced recurrence risk: HR for relapse-free survival was 0.72
- However, the overall survival benefit was not confirmed: HR 1.07
Clinical significance
This is a very important finding precisely because it is not about a powerful new regimen or an innovative drug, but about the proper boundaries of treatment intensity. In real practice, a patient after radical liver surgery often asks: "Do I now need chemotherapy just in case?"
The JCOG0603 trial shows that the answer should not be automatic. Yes, recurrence can be delayed, but that is not the same as actually improving long-term outcomes. An improvement in relapse-free survival does not always translate into improved overall survival.
Limitations
These data do not mean that chemotherapy is never needed after hepatic metastases resection. The trial only shows that routine mFOLFOX6 for all patients after liver surgery did not improve long-term overall survival.
This pertains to a specific situation: colorectal cancer, liver-only metastases, radically resected lesions. Treatment decisions must still account for disease volume, technical aspects of the surgery, recurrence risk, and the overall follow-up plan.
If hepatic metastases have been resected and the next treatment step is being decided
Get a second opinionWhen a second opinion is helpful
- If after liver surgery you are immediately being recommended chemotherapy "by default"
- If physicians disagree about the benefit of post-surgical treatment
- If you want to understand the actual recurrence risk
- If it is important to distinguish the benefit in disease control from the benefit in overall survival
What to prepare for consultation
- Histopathology report for both the primary tumor and metastases
- Postoperative discharge summary from liver surgery
- Description of the number and size of resected lesions
- CT or MRI scans before and after treatment
- Information about prior chemotherapy
- Blood tests and tumor markers, if monitored
Frequently asked questions
Did the trial show that mFOLFOX6 reduces recurrence risk?
Yes. 5-year relapse-free survival was higher: 49.7% vs 40.5%, HR 0.72.
Did the trial show an overall survival benefit?
No. Long-term overall survival was not improved.
Does this mean chemotherapy is never needed after liver surgery?
No. It means the decision should not be automatic and must depend on the specific clinical situation.