Prognostic Factors after Liver Resection for Colorectal Liver Metastasis

Introduction: Surgery is the only potentially curative treatment for patients with colorectal liver metastases, resulting in 5-year survival rates of 36–58%. Although many studies have been performed to determine prognostic factors for tumor recurrence and survival after resection of colorectal liver metastases, there are few prognostic scoring systems stratifying patients undergoing surgery for colorectal liver metastases into risk group models. Objectives: To identify, evaluate and compare the existing prognostic scores for survival after surgery for resection of colorectal liver metastases. Material and Methods: Electronic search in PubMed, Cochrane and Embase from 1990 to 2013 using the terms ‘hepatic resection’, ‘colorectal cancer’, ‘liver metastasis’, ‘hepatectomy’, ‘prognostic’, and ‘score‘. Only studies proposing a prognostic model or risk stratification based on clinical and/or pathological variables were included. Results: From 1996 to June 2013, 19 scoring systems were identified, including one nomogram. Thirty prognostic factors were identified although none of the factors was common to all prognostic models. The 4 factors most often included were: number of liver metastases, regional lymph node metastization of primary tumor, preoperative CEA level and maximum size of metastases. The median study sample size was 305 patients (81-1 568 patients) and median follow-up was 33 months (16-54 months). All studies were retrospective and used the Cox proportional hazards model for multi-variable analysis. Conclusion: Several factors have been constantly reported as having prognostic value after liver resection of colorectal liver metastases, although there is no consensus on the ideal scoring system.

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Is Hepatic Resection Justified After Chemotherapy in Patients With Colorectal Liver Metastases and Lymph Node Involvement?

Journal of Clinical Oncology ◽

10.1200/jco.2007.15.7297 ◽

2008 ◽

Vol 26 (22) ◽

pp. 3672-3680 ◽

Cited By ~ 124

Author(s):

René Adam ◽

Robbert J. de Haas ◽

Dennis A. Wicherts ◽

Thomas A. Aloia ◽

Valérie Delvart ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Lymph Node ◽

Liver Metastases ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Regional Lymph Node ◽

Young Patients ◽

Disease Free Survival ◽

High Risk Group

Purpose For patients with colorectal liver metastases (CLM), regional lymph node (RLN) involvement is one of the worst prognostic factors. The objective of this study was to evaluate the ability of a multidisciplinary approach, including preoperative chemotherapy and hepatectomy, to improve patient outcomes. Patients and Methods Outcomes for a consecutively treated group of patients with CLM and simultaneous RLN involvement were compared with a cohort of patients without RLN involvement. Univariate and multivariate analysis of clinical variables was used to identify prognostic factors in this high-risk group. Results Of the 763 patients who underwent resection at our institution for CLM between 1992 and 2006, 47 patients (6%) were treated with hepatectomy and simultaneous lymphadenectomy. All patients had received preoperative chemotherapy. Five-year overall survival (OS) for patients with and without RLN involvement were 18% and 53%, respectively (P < .001). Five-year disease-free survival rates were 11% and 23%, respectively (P = .004). When diagnosed preoperatively, RLN involvement had an increased 5-year OS compared with intraoperative detection, although the difference was not significant (35% v 10%; P = .18). Location of metastatic RLN strongly influenced survival, with observed 5-year OS of 25% for pedicular, 0% for celiac, and 0% for para-aortic RLN (P = .001). At multivariate analysis, celiac RLN involvement and age ≥ 40 years were identified as independent poor prognostic factors. Conclusion Combined liver resection and pedicular lymphadenectomy is justified when RLN metastases respond to or are stabilized by preoperative chemotherapy, particularly in young patients. In contrast, this approach does not benefit patients with celiac and/or para-aortic RLN involvement, even when patients’ disease is responding to preoperative chemotherapy.

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Prognostic Factors Affecting Survival of Patients after Liver Resection Due to Colorectal Liver Metastases

Macedonian Medical Review ◽

10.1515/mmr-2016-0025 ◽

2016 ◽

Vol 70 (3) ◽

pp. 133-139

Author(s):

Stefan Petrovski ◽

Elena Arabadzhieva ◽

Saso Bonev ◽

Dimitar Bulanov ◽

Valentin Popov ◽

...

Keyword(s):

Prognostic Factors ◽

Liver Resection ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Prognostic Significance ◽

Radical Resection ◽

University Hospital ◽

Tumor Type ◽

Term Survival ◽

Localization Of Metastases

Abstract Introduction. Colorectal liver metastases have a poor prognosis and only 2% have an average 5-year survival if left untreated. In recent decades there has been a development in the diagnosis, treatment and palliative treatment of patients with colorectal liver metastases, and despite radical resection the average five-year survival is between 25% and 44%. Aim. To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the prognostic factors that affect survival after radical surgical treatment of patients. Methods. A retrospective study was conducted at the Clinic of General and Hepato-pancreatic Surgery at the University Hospital “Aleksandrovska”-Sofia. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. Clinical and pathological materials were analyzed using SPSS-19 to determine the prognostic significance of a number of factors in relation to the survival: gender, age, type and localization of metastases, postoperative stage of the primary tumor, type and volume of liver resection, extrahepatic metastases, preoperative values of CEA, postoperative values (AST, ALT). Results. Factors that correlated with lower survival type: metastases (synchronous or metachronus), localization of metastases (uni-or bilobar), presence of the regional lymph node metastases and metastases to other distant organs and the impossibility of radical resection of liver were statistically significant with multivariant analysis. Elevated preoperative value of CEA, the value of hemoglobin and stage IV disease also affected the survival of patients. Conclusion. In patients with colorectal liver metastases only resection has potentially curative character. The surgical strategy for resection in context of increasing the percentage of patients with resectable potential is the only possible factor for long-term survival.

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Do predictive scoring systems have any role in determining treatment strategy for colorectal liver metastases at the individual patient level?

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15104 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15104-e15104

Author(s):

H. Malik ◽

G. Poston

Keyword(s):

Liver Metastases ◽

Scoring System ◽

Colorectal Liver Metastases ◽

Scoring Systems ◽

Prognostic Scores ◽

Published Data ◽

Individual Patient Level ◽

Patient Level ◽

The Individual ◽

Prognostic Scoring Systems

e15104 Background: the literature contains four prognostic scoring systems from large volume series predicting survival after resection for colorectal liver metastases. Our aim was to directly compare these systems in terms of accuracy in predicting survival, and evaluate the role of such systems in determining therapeutic strategies on intention to treat at the individual patient level. Methods: the original published data were reviewed and the median survivals plotted against each point in the scoring system. The best fit line was drawn and the resultant plots enabled calculation of slope of the linear regression line and the square of the Pearson product moment correlation coefficient through data points allowing all four prognostic scoring systems to be directly compared. Results: when the prognostic scores were compared on a common scale, the R-squared values of all the scoring systems were similar with R-squared values of greater than 0.94 in all cases. The Basingstoke Predictive Index however produced the steepest gradient suggesting it can better distribute patients along a wider range of survival. Conclusions: none of the four scoring systems was perfect in their predictive value. It is not surprising that the risk score from MSKCC and Leeds are not as good as the others since they are meant to be preoperative prognostic scores and postoperative scoring system by their nature of having more information should be better. Clearly, future developments in this field must incorporate advances in our understanding of tumor biology. [Table: see text]

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SURGICAL OUTCOMES AND PROGNOSTIC FACTORS IN PATIENTS WITH SYNCHRONOUS COLORECTAL LIVER METASTASES

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032014000100002 ◽

2014 ◽

Vol 51 (1) ◽

pp. 4-9 ◽

Cited By ~ 1

Author(s):

Rafael FONTANA ◽

Paulo HERMAN ◽

Vincenzo PUGLIESE ◽

Marcos Vinicius PERINI ◽

Fabricio Ferreira COELHO ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Liver Metastasis ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Disease Free Survival ◽

Term Survival ◽

Free Survival ◽

Disease Free

Context Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusions Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%.

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Proposal of Two Prognostic Models for the Prediction of 10-Year Survival after Liver Resection for Colorectal Metastases

HPB Surgery ◽

10.1155/2018/5618581 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Ulf Kulik ◽

Mareike Plohmann-Meyer ◽

Jill Gwiasda ◽

Joline Kolb ◽

Daniel Meyer ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

External Validation ◽

Prognostic Models ◽

Colorectal Metastases ◽

Receiver Operating Curve ◽

Resection Margins ◽

Patient Counselling ◽

Receiver Operating

Background. One-third of 5-year survivors after liver resection for colorectal liver metastases (CLM) develop recurrence or tumor-related death. Therefore 10-year survival appears more adequate in defining permanent cure. The aim of this study was to develop prognostic models for the prediction of 10-year survival after liver resection for colorectal liver metastases. Methods. N=965 cases of liver resection for CLM were retrospectively analyzed using univariable and multivariable regression analyses. Receiver operating curve analyses were used to assess the sensitivity and specificity of developed prognostic models and their potential clinical usefulness. Results. The 10-year survival rate was 15.2%. Age at liver resection, application of chemotherapies of the primary tumor, preoperative Quick’s value, hemoglobin level, and grading of the primary colorectal tumor were independent significant predictors for 10-year patient survival. The generated formula to predict 10-year survival based on these preoperative factors displayed an area under the receiver operating curve (AUROC) of 0.716. In regard to perioperative variables, the distance of resection margins and performance of right segmental liver resection were additional independent predictors for 10-year survival. The logit link formula generated with pre- and perioperative variables showed an AUROC of 0.761. Conclusion. Both prognostic models are potentially clinically useful (AUROCs >0.700) for the prediction of 10-year survival. External validation is required prior to the introduction of these models in clinical patient counselling.

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Radiofrequency ablation of colorectal liver metastases

Perspectives in Surgery ◽

10.33699/pis.2019.98.10.399-403 ◽

2019 ◽

Vol 98 (10) ◽

Keyword(s):

Radiofrequency Ablation ◽

Liver Resection ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Postoperative Mortality ◽

Disease Free Survival ◽

Female Ratio ◽

Liver Resections ◽

Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

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