Aggressive regional therapy vs conventional treatment of patients with unresected liver metastases from colorectal cancer: A multivariate analysis focused on overall survival

Abstract

3675 Background: The prognosis of unresected colorectal (CRC) liver metastases is poor. Most patients receive systemic chemotherapy or supportive care only. There is suggested survival benefit with aggressive regional treatment such as hepatic artery infusion (HAI), radiofrequency ablation (RFA), and cryosurgical ablation (CSA). We have analyzed various therapies for unresected liver metastases to determine survival impact. Methods: Survival was analyzed in 173 patients with hepatic metastases from CRC according to variables of: site (colon vs rectum) and stage of the primary tumor (ages +/− 65 years), gender, timing of metastases (synchronous vs metachronous), extent of metastatic disease (regional vs regional plus extra hepatic), and type of treatment. The latter included primary tumor resection (yes/no), systemic therapy vs supportive care, and treatment of liver metastases by regional therapy (HAI,RFA,CSA) vs systemic therapy or supportive care. Survival results were compared by univariate and multivariate analysis according to Log-rank and proportional hazard regression. Results: The median and five-year overall survival of the entire series was 13 months and 1.6% respectively. Multivariate analysis showed a better survival in patients who had primary tumor resection (p=0.001), had early stage disease (p=0.001), and had metachronous (vs. synchronous) metastases (p=0.02). Extent of metastatic disease and treatment of liver metastases were significant only in univariate analysis (p=0.01 and 0.0008 respectively). Site of the primary tumor, gender, chronologic age, and type of systemic treatment did not effect overall or median survival. Conclusions: Although survival is poor with unresected liver metastases from CRC, prognosis is better in patients with early stage, whos primary cancer is resected, and who develop metachronous vs synchronous metastases. If extent of metastases precludes liver resection (potentially curable), removal of the primary cancer is of value. Aggressive regional treatment has palliative value and may improve survival and quality of life. Clinical trials are warranted to test these issues. No significant financial relationships to disclose.