P-191 Prognostic factors of colorectal cancer liver metastasectomy

Abstract

In selected patients with metastatic colorectal cancer (MCRC), resection of liver metastases may offer the possibility of cure. The aim of this study was to evaluate possible preoperative prognostic factors for survival in patients with MCRC undergoing liver metastasectomy in order to select the ideal patient for this procedure. Retrospective analysis of 121 patients with MCRC followed at our center, who underwent liver metastasectomy with curative intent and who underwent primary chemotherapy between March 2004 and June 2017. Survival analyses was estimated through Kaplan-Meier method and multivariate analyses through Cox regression. The median age at diagnosis was 58 (19-79) and 61% were men. The median follow-up time was 53 months (10-143). The recurrence rate after the first metastasectomy was 73.6%. The median DFS after the first liver metastasectomy was 13 months (95% CI, 10.3-15.6). The median OS was 63 months (95% CI, 48.6-77.4). The preoperative factors which gave the worst prognosis in the analysis for OS and DFS were: the presence of ≥3 metastatic liver lesions (median OS: 101 months, CI 95% 57.4-144.6 vs 51 months, CI 95% 42.0-59.9, p = 0.010; DFS median: 18 months, CI 95% 0.0-36.9 vs 10 months, CI 95% 7.2-12.8, p = 0.013), extrahepatic metastasis (median OS: 71 months, CI 95% 58.4-83.6 vs 37 months, CI 95% 22.6-51.4, p = 0.001; median DFS: 15 months, CI 95% 12.2-17.8 vs 7 months, CI 95% 4.3-9.7, p = 0.002), pT4 (median OS: 65 months, CI 95% 50.2-79.8 vs 34 months, CI 95% 25.4-42.6, p = 0.008; Median DFS: 14 months, CI 95% 10.9-17.1 vs 5 months, CI 95% 2.9-7.1, p = 0.011), size of metastases ≥60 mm (median OS: 80 months, CI 95% 63.7-96.3 vs 51 months, CI 95% 42.8-59.2, p = 0.020; DFS median: 16 months, CI 95% 11.9-20.1 vs 10 months, CI 95% 7.4-12.6, p = 0.020). The factors which maintained a negative impact in the multivariate analysis for OS and DFS were pT4 (OS: p = 0.020, HR 1.98, CI 95% 1.1-3.5; DFS: p = 0.007, HR 2.11, CI 95% 1.2-3.6) and extrahepatic metastasis (OS: p = 0.011, HR 2.05, CI 95% 1.2-3.6; DFS: p = 0.024, HR 1.85, CI 95% 1.1-3.2). The presence of ≥3 metastatic liver lesions, extrahepatic metastasis, pT4 and the size of metastases ≥60 mm had a negative impact on OS and DFS.