Comparison of the clinicopathological characteristics and their impact on outcomes of resected colorectal liver metastases across time
Abstract Background: Resection of colorectal liver metastases (CLM) has been established as the standard of care. This study aims to compare the change in clinicopathological characteristics of patients who underwent curative resection of CLM across two time periods – 2000 to 2010 (T1) and 2011 to 2016 (T2) and evaluate the prognostic impact of these characteristics on survival outcomes. Methods: Patients who undergo liver resection for CLM at Singapore General Hospital from January 2000 to December 2016 were identified from a prospectively maintained database. The primary end point was overall survival. ResultsThere were 183/318 (57.5%) patients and 135 /318 (42.5%) patients in T1 and T2 respectively. There was a lower proportion of patients who had nodal metastases from primary colorectal cancer and clinical risk score (CRS) less than 3 in T2 when compared to T1. There was no difference in survival between both time periods (HR 0.850 95% CI 0.601 – 1.201 p = 0.357). Independent predictors of survival for the cohort were CEA levels ≥200ng/ml, primary tumour grade and lymph nodal status. Independent predictors of poor survival in T1 were poorly differentiated colorectal cancer and nodal metastases while in T2, independent predictors of poor survival were multiple liver metastases and nodal metastases.Conclusion: Nodal metastases from primary colorectal cancer is an independent predictor of poor survival across time for resectable CLM. Although there is no difference in survival between the two time periods, patients with multiple liver metastases should be carefully considered prior to surgery as it is also an independent predictor of overall survival.