Abstract
Background and purposeThe outcomes and management of colorectal cancer (CRC) hepatic metastasis have undergone many evolutionary changes. In this study, we aimed to analyze the outcomes of patients with CRC hepatic metastasis in terms of the era of treatment.MethodsWe conducted a retrospective review of 279 patients who underwent liver resection (LR) for CRC hepatic metastases. The prognoses of patients treated pre-2003 (era 1) and post-2003 (era 2) were examined.ResultsOf the patients included in the study, 210 (75.3%) had CRC recurrence after LR. There was a significant difference in the ratio of CRC recurrence between the 2 eras (82.0% in era 1 vs. 69.5% in era 2; p = 0.008). Analysis of recurrence-free and overall survival rates also showed that the patient outcome was significantly better in the post-2003 era than in the pre-2003 era. Further analysis showed that a significantly higher percentage of patients in era 2 had received modern chemotherapeutic regimens including irinotecan and oxaliplatin, while patients in era 1 were mainly administered fluorouracil and leucovorin for adjuvant chemotherapy. Among patients with CRC recurrence, a significant ratio of those in era 2 underwent surgical resection for recurrent lesions, and these patients had a better survival curve than did patients without resection (34.1% vs. 2.2% for 5-year survival; p < 0.0001).ConclusionThe incidence of CRC recurrence after LR for hepatic metastasis remains very high. However, the management and outcomes of patients with CRC hepatic metastasis have greatly improved with time, suggesting that the current use of aggressive multimodality treatments including surgical resection combined with modern chemotherapeutic regimens effectively prolongs the life expectancy of these patients.
Highlights
Background and purposeThe outcomes and management of colorectal cancer (CRC) hepatic metastasis have undergone many evolutionary changes
Patients in era 2 were older, had a higher percentage of multiple hepatic metastases (44.4% in era 2 vs. 24.2% in era 1; p < 0.001), had a lower rate of CRC recurrence (69.5% vs. 82.0%; p = 0.008), and received perioperative chemotherapeutic regimens different from those in era 1 (p < 0.0001)
Further detailed analysis regarding chemotherapies showed that a higher percentage of patients in era 2 received fluorouracil and leucovorin combined with irinotecan and oxaliplatin, while patients of era 1 were mainly administered fluorouracil and leucovorin for adjuvant chemotherapy
Summary
Background and purposeThe outcomes and management of colorectal cancer (CRC) hepatic metastasis have undergone many evolutionary changes. We aimed to analyze the outcomes of patients with CRC hepatic metastasis in terms of the era of treatment. Hepatic metastasis is the most common form of distant spread of primary colorectal cancer (CRC) and occurs in over 50% of patients with metastases. Despite the excellent results of aggressive treatment for the prognostic factors and scoring systems that determine patient outcomes after LR are well established,[4,9,10,11] most of the information regarding LR for metastatic CRC is from Western countries. Since the treatment of metastatic CRC has changed greatly over the last decade, the patient cohort was grouped according to the timeframe of treatment to evaluate the evolution of outcome over the years
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