Abstract
Numerous factors affect the prognosis of colorectal liver metastasis (CRLM) patients after hepatic resection. We investigated several factors related to overall survival in patients with CRLM to identify those most likely to benefit from hepatic resection, and produced a rational tumor biology score system. Three hundred CRLM patients treated with preoperative chemotherapy followed by hepatic resection between 2006 and 2016 were enrolled in our study. Clinicopathologic and long-term survival data were collected and assessed. Patient 1-, 3-, and 5-year overall survival rates were 92.7%, 58.3%, and 45.8%, respectively, while 1-, 3-, and 5-year disease-free survival rates were 44.7%, 28.6%, and 24.2%, respectively. Multivariate Cox regression analysis revealed poor preoperative chemotherapy response, Fong clinical risk score > 2, and KRAS mutation to be independent prognostic indicators in CRLM patients. As part of a preoperative staging system in which one point was assigned for each factor, a total score (out of 3) was predictive of long-term survival following surgery. These factors facilitate personalized prognostic assessments in CRLM patients planning for resection.
Highlights
50% of patients with primary colorectal cancer will develop liver metastases during their disease course [1]
We investigated several factors related to overall survival in patients with colorectal liver metastasis (CRLM) to identify those most likely to benefit from hepatic resection, and produced a rational tumor biology score system
Major hepatic resection was performed in 135 patients (45.0%). 190 patients had a KRAS mutation, 155 had a Fong clinical risk score (CRS) > 2, and 182 exhibited poor response to preoperative chemotherapy
Summary
50% of patients with primary colorectal cancer will develop liver metastases during their disease course [1]. Hepatic resection remains the only potentially curative treatment option for patients with colorectal liver metastasis (CRLM). Criteria used to select CRLM patients for hepatic resection are based largely on clinical and radiologic parameters, such as tumor size and number, and response to preoperative chemotherapy, that attempt to predict prognosis post-resection [4,5,6]. Preoperative chemotherapy can shrink metastases and increase their resectability, and may help select patients most likely to benefit from surgery [7, 8]. The present study investigated various tumor-related factors to develop a scoring system to predict CRLM patient survival following hepatic resection
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