Three-Dimensional Length from the Center of the Liver is a Prognostic Factor of Colorectal Cancer with Liver Metastasis: A Retrospective Analysis
Abstract Background Resectability of liver metastasis is important to establish a treatment strategy for colorectal cancer patients. We aimed to evaluate the effect of distance from metastasis to the center of the liver on the resectability and patient outcomes after hepatectomy. Methods Clinical data of a total of 124 patients who underwent hepatectomy for colorectal cancer with liver metastasis were retrospectively reviewed. We measured the minimal length from metastasis to the bifurcation of the portal vein at the primary branch of the Glissonean tree and defined it as “Centrality”. Predictive effects on positive resection margin and overall survival of centrality were statistically analyzed. Results The value as a predictive factor for the positive resection margin of centrality was analyzed by the receiver operating characteristic curve (area under the curve = 0.72, P<0.001). In multivariate analysis, total number of metastases ≥ 3 and centrality ≤ 1.5 cm were significant risk factors of overall survival. Patients with these two risk factors (n=21) had worse 5-year overall survival (10.7%) than patients with one (n=35, 58.3%) or no risk factor (n=68, 69.2%). In subgroups analysis, neoadjuvant chemotherapy improved overall survival in patients with these two risk factors. Conclusion Centrality was related with a positive resection margin and had a negative effect on survival. By combining the total number of metastases with centrality, we could determine disease prognosis and neoadjuvant chemotherapy indications for advanced colorectal cancer with liver metastasis.