Accelerated liver hypertrophy is associated with recurrence in patients with colorectal liver metastases

Abstract

Introduction: While concerns exist regarding an association between rapid liver hypertrophy and tumor progression, published data are controversial. This study aimed to investigate whether extensive liver regeneration after portal vein embolization (PVE) was associated with recurrence or long-term outcome for patients with colorectal liver metastases (CRLM). Methods: Patients who underwent PVE before hepatectomy for CRLM between 2000 and 2015 were evaluated retrospectively. Patients with extrahepatic disease, post-hepatectomy liver failure and 90-day mortality were excluded. Kinetic Growth Rate (KGR) was defined as degree of hypertrophy at initial liver volumetry divided by the weeks elapsed after PVE. Receiver operating characteristic (ROC) analysis was performed to determine the KGR cut-off value that predicted recurrence. Survival analysis was performed using log-rank statistic and Cox regression. Results: The study included 99 patients. Based on ROC analysis, a KGR ≥2.7 %/week was identified as predicting tumor recurrence (AUC 0.67, p=0.039). Oncological characteristics were comparable between patients with higher (≥2.7 %/week) and lower (< 2.7 %/week) KGR. Patients with higher vs. lower KGR had significantly worse recurrence-free (RFS) (5-year rate 7.9% vs. 39%, p=0.0002) and overall survival (OS) (5-year rate 34.1% vs. 48.9%, p=0.016). Multivariate analysis revealed higher KGR as the only factor significantly associated with RFS (HR 2.37, p=0.002) and OS (HR 2.03, p=0.035). Conclusion: KGR identifies a subset of patients with worse survival. Understanding the growth factor and cytokine interplay following PVE that may promote tumor growth may allow for the identification of novel therapeutic angles.