Abstract
The aim of this study was to identify prognostic factors affecting intrahepatic progression-free survival (ihPFS) and overall survival (OS) in patients with colorectal cancer liver metastases (CRCLM) undergoing portal vein embolization (PVE) and subsequent (extended) right hemihepatectomy. A total of 59 patients (mean age: 60.8 ± 9.3 years) with CRCLM who underwent PVE in preparation for right hemihepatectomy were included. IhPFS and OS after PVE were calculated using the Kaplan–Meier method. Cox regression analyses were conducted to investigate the association between the following factors and survival: patient age, laterality of the colorectal cancer (right- versus left-sided), tumor location (colon versus rectal cancer), time of occurrence of hepatic metastases (synchronous versus metachronous), baseline number and size of hepatic metastases, presence or absence of metastases in the future liver remnant (FLR) before PVE, preoperative carcinoembryogenic antigen (CEA) levels, time between PVE and surgery, history of neoadjuvant or adjuvant chemotherapy, and the presence or absence of extrahepatic disease before PVE. Median follow up was 18 months. The median ihPFS was 8.2 months (95% confidence interval: 6.2–10.2 months), and median OS was 34.1 months (95% confidence interval: 27.3–40.9 months). Laterality of the primary colorectal cancer was the only statistically significant predictor of ihPFS after PVE (hazard ratio (HR) = 2.242; 95% confidence interval: 1.125, 4.465; p = 0.022), with patients with right-sided colorectal cancer having significantly shorter median ihPFS than patients with left-sided cancer (4.0 ± 1.9 months versus 10.2 ± 1.5 months; log rank test: p = 0.018). Other factors, in particular also the presence or absence of additional metastases in the FLR, were not associated with intrahepatic progression-free survival. The presence of extrahepatic disease was associated with worse OS (HR = 3.050, 95% confidence interval: 1.247, 7.459; p = 0.015).
Highlights
1.1.IntroductionLivermetastases metastasesininpatients patientswith with colorectal cancer (CRC)common occur in aboutLiver colorectal cancer areare common andand occur in about oneone-fourth of patients within the first years after diagnosis of the primary tumor [1,2].Surgery fourth of patients within the first 5 years after diagnosis of the primary tumor [1,2]
None of the remaining factors investigated such as for example size and number of liver metastases before Portal vein embolization (PVE), pre-existing tumor in the future liver remnant (FLR) or the time of detection liver metastases and pre- or postoperative systemic chemotherapy treatment were associated with intrahepatic progression-free survival (ihPFS)—which means that these factors either do not, or at least not to the same extent, impact ihPFS as does tumor biology
The results of this study in terms of ihPFS are in good agreement with the observation that right-sided and left-sided CRCs differ with regard to their respective molecular and biological features, with right-sided CRCs being biologically more aggressive cancers, occurring in younger patients, and being associated with a reduced overall survival compared to their left-sided counterparts [13,14]
Summary
1.1.IntroductionLivermetastases metastasesininpatients patientswith with colorectal cancer (CRC)common occur in aboutLiver colorectal cancer areare common andand occur in about oneone-fourth of patients within the first years after diagnosis of the primary tumor [1,2].Surgery fourth of patients within the first 5 years after diagnosis of the primary tumor [1,2]. Livermetastases metastasesininpatients patientswith with colorectal cancer (CRC). Liver colorectal cancer areare common andand occur in about oneone-fourth of patients within the first years after diagnosis of the primary tumor [1,2]. Surgery fourth of patients within the first 5 years after diagnosis of the primary tumor [1,2]. Surgeryisisthe the standardtreatment treatmentin in patients patients with with resectable, standard resectable, oligometastatic oligometastatic liver liverdisease, disease,since sincecomplete completeresection resection prolongsoverall overallsurvival survivaland andisispotentially potentiallycurative curativein in20–50%. 20–50%of ofpatients patients[3,4,5]. Is routinely used to induce growth of the future remnant. Portal vein embolization (PVE) is routinely used to induce growth of the future liverliver remnant (FLR)
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