Predictive factors for time to recurrence, treatment and post-recurrence survival in patients with initially resected colorectal liver metastases

Purpose Complete clinical response (CCR) of colorectal liver metastases (CLM) following chemotherapy is of limited predictive value for complete pathologic response (CPR) and cure of the disease. The objective of this study was to determine predictive factors of CPR as well as its impact on survival. Patients and Methods From January 1985 to July 2006, 767 consecutive patients with CLM underwent liver resection after systemic chemotherapy. Patients with CPR were compared with patients without CPR. Results Twenty-nine of 767 (4%) patients had CPR, and none of these 29 patients had CCR. Patients with CPR (mean age, 54 years) had a mean number of 3.3 metastases at diagnosis (mean size, 29.3 mm). Objective response and stable disease were observed in 79% and 21% of cases, respectively. Postoperative mortality rate was 0%. After a median follow-up of 52.2 months (range, 1.1 to 193.0 months), overall 5-year survival was 76% for patients with CPR compared with 45% for patients without CPR (P = .004). Independent predictive factors for CPR were: age ≤ 60 years, size of metastases ≤ 3 cm at diagnosis, carcinoembryonic antigen (CEA) level at diagnosis ≤ 30 ng/mL, and objective response following chemotherapy. The probability of CPR ranged from 0.2% when all factors were absent to 30.9% when all were present. Conclusion CPR was observed in 4% of patients with CLM treated with preoperative chemotherapy. However, CPR may occur in almost one-third of objective responders age ≤ 60 years with metastases ≤ 3 cm and low CEA values. CPR is associated with uncommon high survival rates.

Download Full-text

Perioperative Blood Transfusions are Associated with Decreased Time to Recurrence and Decreased Survival after Resection of Colorectal Liver Metastases

Annals of Surgery ◽

10.1097/00000658-198812000-00002 ◽

1988 ◽

Vol 208 (6) ◽

pp. 679-687 ◽

Cited By ~ 179

Author(s):

KEITH R. STEPHENSON ◽

SETH M. STEINBERG ◽

KEVIN S. HUGHES ◽

JOHN T. VETTO ◽

PAUL H. SUGARBAKER ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Blood Transfusions ◽

Time To Recurrence

Download Full-text

A New Surveillance Algorithm After Resection of Colorectal Liver Metastases Based on Changes in Recurrence Risk and RAS Mutation Status

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7596 ◽

2020 ◽

Vol 18 (11) ◽

pp. 1500-1508 ◽

Cited By ~ 1

Author(s):

Yoshikuni Kawaguchi ◽

Scott Kopetz ◽

Heather A. Lillemoe ◽

Hyunsoo Hwang ◽

Xuemei Wang ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Statistical Tests ◽

Recurrence Risk ◽

Wild Type ◽

Surveillance Strategy ◽

Time To Recurrence ◽

Risk Factors For Recurrence ◽

Primary Lymph Node

Background: The optimal surveillance strategy after resection of colorectal liver metastases (CLM) is unknown. We evaluated changes in recurrence risk after CLM resection and developed a surveillance algorithm. Methods: Patients undergoing CLM resection during 1998 to 2015 were identified from a prospectively compiled database and analyzed if they had the potential for follow-up longer than the longest observed time to recurrence in this cohort. Changes in recurrence risk and risk factors for recurrence were evaluated. All statistical tests were 2-sided. Results: Among 2,105 patients who were initially identified and underwent CLM resection, the latest recurrence was observed at 87 months; 1,221 consecutive patients from 1998 through 2011 with the potential for at least 87 months of follow-up were included. The risk of recurrence was highest at 0 to 2 years after CLM resection, lower at 2 to 4 years after CLM resection, and steadily lower after 4 years after CLM resection. Factors associated with increased recurrence risk at the time of surgery were primary lymph node metastasis (hazard ratio [HR], 1.54; 95% CI, 1.21–1.97; P<.001), multiple CLM (HR, 1.31; 95% CI, 1.06–1.63; P=.015), largest liver metastasis diameter >5 cm (HR, 1.64; 95% CI, 1.23–2.19; P<.001), and RAS mutation (HR, 1.29; 95% CI, 1.04–1.59; P=.020). In patients without recurrence at 2 years, the only factor still associated with increased recurrence risk was RAS mutation. In those patients, the recurrence rate at 4 years was 59.3% in patients with RAS mutation versus 27.8% in patients with RAS wild-type (P=.019). Conclusions: For patients who have undergone CLM resection, we propose surveillance every 3 to 4 months during years 0 to 2, every 3 to 4 months (if mutant RAS) versus every 4 to 6 months (if RAS wild-type) during years 2 to 4, and every 6 to 12 months if recurrence-free at 4 years.

Download Full-text

Analysis of predictive factors for recurrence after hepatectomy for colorectal liver metastases

World Journal of Surgery ◽

10.1007/bf03215859 ◽

2001 ◽

Vol 25 (9) ◽

pp. 1129-1133 ◽

Cited By ~ 37

Author(s):

Hidehisa Yamada ◽

Satoshi Kondo ◽

Shunichi Okushiba ◽

Toshiaki Morikawa ◽

Hiroyuki Katoh

Keyword(s):

Liver Metastases ◽

Predictive Factors ◽

Colorectal Liver Metastases

Download Full-text

Complete pathological response of colorectal liver metastases after neoadjuvant chemotherapy: myth or reality?

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4063 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4063-4063 ◽

Cited By ~ 1

Author(s):

D. A. Wicherts ◽

R. J. Haas de ◽

F. Levi ◽

T. Aloia ◽

B. Paule ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Liver Metastases ◽

Predictive Factors ◽

Colorectal Liver Metastases ◽

Objective Response ◽

Disease Free Survival ◽

Pathological Response ◽

Maximum Diameter ◽

High Survival ◽

Complete Pathological Response

4063 Background: A complete clinical response (CCR) of colorectal liver metastases (CLM) following chemotherapy has been shown unrelated to the real disappearance of active tumor. By contrast, a complete pathological response (PCR) could be more clinically relevant, but has not been explored. The aim of this study was to evaluate the incidence and outcome as well as predictive factors of PCR, in patients resected from CLM after neoadjuvant chemotherapy. Methods: In our institution 791 consecutive patients with CLM underwent liver resection after neoadjuvant chemotherapy. CCR was defined as the disappearance of all lesions after chemotherapy, and PCR was defined as the total necrosis of all metastases on the resection specimen. Both were selected from a prospective database. Patients with and without PCR were compared, survivals were determined and predictive factors for PCR were analyzed using a multivariate risk model. Results: There were 0.4% CCR (3/791) and 4% PCR (31/791). Among the 31 patients with PCR, the median number of CLM was 2.0 (range 1–13) with a maximum diameter = 3 cm for most cases (73%) at diagnosis. Ten patients (32%) had extrahepatic metastases. Compared to patients without PCR, patients with PCR were younger (p< 0.05) and had a smaller maximum tumor size (p=0.007). Rate of objective response was higher (81% vs. 52%; p=0.002) and last chemotherapy regimen contained more frequently oxaliplatin than irinotecan (p=0.05). Number of chemotherapy cycles and treatment lines were not different. At multivariate analysis, 4 predictive factors of PCR were identified: age = 60 yrs, maximum size at diagnosis = 3 cm, CEA = 40 ng/ml at diagnosis and achievement of an objective response. The probability of PCR ranged from 0.2% when all were absent to 33.8% when all were present. PCR strongly impacted overall survival (OS) that was 69% and 62% at 5 and 10 years with a disease-free survival (DFS) of 42% for both. Conclusions: PCR concerns overall 4% of patients receiving neoadjuvant chemotherapy allowing for surgery, but as much as one third of those aged less than 60 years, developing response on liver metastases smaller than 3 cm, with low CEA values. Uncommon high survival rates are observed in this setting. PCR more than CCR is a reality and strongly impacts patient outcome. No significant financial relationships to disclose.

Download Full-text