Predictive factors for time to recurrence, treatment and post-recurrence survival in patients with initially resected colorectal liver metastases.

Jon-Helge Angelsen,Arild Horn,Dag Hoem,Inger Marie Løes,Geir Egil Eide,Halfdan Sorbye,Asgaut Viste

doi:10.1186/s12957-015-0738-8

Abstract

BackgroundDespite progress in resection for colorectal liver metastases (CLM), the majority of patients experience recurrence. We aimed to evaluate factors influencing time to recurrence (TTR), treatment and post-recurrence survival (PRS) related to site of recurrence.MethodsThis is a retrospective population-based cohort study (1998–2012) of consecutive patients without extrahepatic disease treated with resection for CLM in a referral centre.ResultsA total of 311 patients underwent resection for CLM. After a median follow-up of 4.2 years (range 1.2–15.2), 209 (67.4 %) patients developed recurrence, hepatic 90, extrahepatic 59 and both 60. Median TTR was 14.0 months, and 5-year recurrence-free status was 25.7 %. Five- and 10-year overall survival (OS) was 38.8 and 22.0 %, respectively. Median OS was 45 months. A multivariate analysis displayed synchronous disease (hazard ratio (HR) 1.50), American Society of Anaesthesiologists (ASA) score (HR 1.40), increasing number (HR 1.24) and size of metastases (HR 1.08) to shorten TTR (all p < 0.05). Perioperative chemotherapy (n = 59) increased overall TTR (HR 0.63) and overall survival (OS; HR 0.55). Hepatic TTR was correlated to synchronous disease (HR 2.07), number of lesions (HR 1.20), R1 resection (HR 2.00) and ASA score (HR 1.69), whereas extrahepatic TTR was correlated to N stage of the primary (HR 1.79), number (HR 1.27) and size of metastases (HR 1.16). Single-site recurrence was most common (135 of 209, 64.5 %), while 58 patients had double- and 16 triple-site relapses. Median PRS was 24.3 months. There was a difference in median PRS (months) according to site of relapse: liver 30.5, lung 32.3, abdominal 22.0, liver and lung 14.3, others 14.8 (p = 0.002). Repeated liver resections were performed in n = 57 patients resulting in 40.6 months median OS and 36.8 % 5-year OS.ConclusionsAn adverse overall TTR was correlated to number and size of metastases, ASA score and synchronous disease. Perioperative chemotherapy increased TTR and OS after surgery for CLM. Patients with solitary post-resection relapse in the liver or lungs had the potential for longevity due to multimodal treatment.

Highlights

Despite progress in resection for colorectal liver metastases (CLM), the majority of patients experience recurrence
time to recurrence (TTR) was associated with number and size of metastases, synchronous disease, increasing American Society of Anaesthesiologists (ASA) score and perioperative chemotherapy in the multivariate analysis (Tables 2 and 3)
Hepatic TTR correlated with synchronous CLM, ASA score, R1 resections and number of metastases

Summary

Introduction

Despite progress in resection for colorectal liver metastases (CLM), the majority of patients experience recurrence. Surgical intervention (resection or local ablation) is the only potentially curative option for patients with colorectal liver metastases (CLM). By multimodal treatment like chemotherapy, radiofrequency ablation (RFA) and portal vein embolization, some patients have achieved downsizing of initially unresectable CLM and might be offered a potentially curative resection [4]. Perioperative chemotherapy has improved progression-free survival [5] and overall survival (OS) in the adjuvant setting [6]. Following these advancements, OS has increased to 47– 58 % in several series [3, 7, 8]. For patients beyond the range of cure, optimal oncological therapy may yield life extension [14, 15]

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