Survival and Prognostic Factors of Colorectal Liver Metastases After Surgical and Nonsurgical Treatment

• Published in: Clinical colorectal cancer 2016-12, Vol.15 (4), p.e183-e192
• Main Authors: Lemke, Johannes, Cammerer, Gregor, Ganser, Johannes, Scheele, Jan, Xu, Pengfei, Sander, Silvia, Henne-Bruns, Doris, Kornmann, Marko
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Catheter Ablation; Colorectal cancer; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Female; Hepatectomy; Humans; Liver metastases; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Male; Middle Aged; Prognosis; Resection; Surgery; Survival; Survival Analysis
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2016.04.007

In this study, we prospectively analyzed the survival of 506 patients with colorectal liver metastases. The outcome was compared after surgical and nonsurgical treatment side-by-side, and independent prognostic factors were identified. Importantly, surgical resection was associated with strongly improved survival, even when repeated resections were performed for recurrent metastases. Consequently, surgical treatment is the first choice for colorectal liver metastases. Colorectal cancer is one leading cause of cancer-related death worldwide, and distant metastases determine an unfavorable prognosis. Surgical resection of colorectal liver metastases (CRLM) improves survival and provides the chance for cure. The aim of this study was to prospectively analyze the outcome of patients with CRLM in a population-based manner, and thereby, to compare the prognosis of patients undergoing resection with those receiving nonsurgical treatment. Moreover, we set out to identify and confirm important prognostic factors after resection of CRLM. We analyzed the outcome of 506 patients diagnosed with CRLM in our institution from 1996 to 2011. Survival and the impact of clinical and pathologic factors were analyzed by univariate analysis. Important independent prognostic factors were analyzed by multivariate analysis. The 5-year overall survival rate (5y-OSR) for patients receiving resection of CRLM (n = 152) was 46% (95% confidence interval (CI), 37%-54%) compared with a 5y-OSR of 6% (95% CI, 4%-9%) for patients treated nonsurgically (n = 354). There was no perioperative mortality. Multivariate analysis revealed, among other factors, good performance status of the patient (low American Society of Anesthesiologists score), the absence of extrahepatic metastases, < 5 metastatic lesions, and a tumor-free resection margin (R0) as important, independent prognostic factors. Importantly, repeated hepatic resections of CRLM performed in 13 patients were associated with an excellent outcome (5y-OSR, 47%; 95% CI, 17%-72%). Surgical resection, which can be performed with tolerable site-effects, is the first choice for patients diagnosed with metachronous and synchronous CRLM. Of note, repeated resections should be advised in recurrent intrahepatic colorectal cancer whenever possible.