Abstract
The aims of this study were to assess early recurrence predictive factors and elucidate the best early recurrence management. 255 patients with colorectal liver metastases (CRLM) who underwent hepatectomy were retrospectively analyzed. A total of 87 patients (34.1%) developed early recurrence, defined as recurrence that occurred within 6 months after resection. Multivariate analysis showed that preoperative carcino-embryonic antigen (CEA) level ≥ 30 ng/ml, primary tumor lymphovascular invasion (LVI), number of metastases ≥ 4, R1 resection and initially unresectable disease were independent predictors of early recurrence. A predictive scoring system for early recurrence was created by incorporating these factors, and this system showed good discrimination (concordance index of 0.78). In early recurrent patients who underwent salvage treatment, those with 0–2 risk factors demonstrated a significantly longer median survival after recurrence than patients with 3–5 risk factors (33.4 months vs. 20.2 months, p = 0.001). For patients who underwent chemotherapy alone, the median survival after recurrence between two groups was comparable (18.3 months vs. 22.6 months, p = 0.926). Multivariate analysis revealed that primary tumor lymph node metastases (HR = 1.96, p = 0.032), early recurrence (HR = 1.67, p = 0.045), salvage treatment for recurrence (HR = 0.47, p = 0.002) and predictive scores for early recurrence (HR = 1.39, p = 0.004) were independent factors for survival in patients with recurrence. In patients with early recurrence, bilobar distribution of metastases (HR = 2.05, p = 0.025) and salvage treatment for recurrence (HR = 0.46, p = 0.019) were independent factors for survival. In conclusion, we developed a predictive model that is a very useful tool for determining both the likelihood of early recurrence and the necessity for salvage treatment.
Highlights
Liver is the most frequent site for metastasis from colorectal cancer, with more than 50% of patients developing hepatic metastases during the course of the disease [1]
Multivariate analysis showed that preoperative carcino-embryonic antigen (CEA) level ≥ 30 ng/ml, primary tumor lymphovascular invasion (LVI), number of metastases ≥ 4, R1 resection and initially unresectable disease were independent predictors of early recurrence
It was hypothesized that patients who developed early recurrence could benefit little from hepatectomy [9], our results showed these patients had a median survival of 26.3 months, better than the reported survival of patients who receive chemotherapy alone [19,20]
Summary
Liver is the most frequent site for metastasis from colorectal cancer, with more than 50% of patients developing hepatic metastases during the course of the disease [1]. Liver resection, combined with modern chemotherapy, is considered the standard treatment for patients with resectable CRLM [2,3]. 5-year survival can approach 50% after resection of liver metastases [4]. Recurrence occurs in 50%–75% of the patients after surgery [5,6], remaining a major problem. Www.impactjournals.com/oncotarget active surveillance, earlier adjuvant chemotherapy and intensive chemotherapy regimen may be required for patients with high risk of early recurrence after liver resection for CRLM. Prognostic factors of early recurrence are not completely clear
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