Abstract
The objective of the present study was to explore the factors related to the prognosis of colorectal cancer (CRC) and to establish a prognostic model for the selection of patients who might benefit from hepatic resection for metastatic CRC. A total of 293 patients undergoing liver resection for metastatic CRC (172 males and 80 females ranging in age from 26 to 80 years) were selected and clinical, pathological and outcome data were examined in this retrospective study. The prognostic index (PI) of the patients was calculated on the basis of results of multivariate analysis. Patients were stratified into different groups, with survival curves projected according to PI. The 1-, 3-, and 5-year overall survival rates were 58.3, 26.4, and 11.3%, respectively. Univariate analysis indicated that degree of primary tumor differentiation, resection margin, preoperative carcinoembryonic antigen (CEA) level, number of liver metastases, and resection of liver metastases were associated with prognosis (P < 0.05). In multivariate analysis, the last three factors were found to be independent prognostic factors. The resection of liver metastases was a favorable factor. Patients were classified into three groups according to PI, which differed significantly in survival rate (P < 0.05). The individual survival rate was evaluated based on PI. Resection of hepatic colorectal metastases may produce long-term survival and cure. The proposed PI was easy to use, was highly predictive of patient outcome, and permitted categorization of patients into treatment groups.
Highlights
Colorectal carcinoma (CRC) is a common malignancy of the digestive system and up to 50% of affected patients will develop metastases during the course of their disease [1,2]
Several variables were analyzed by univariate and multivariate methods to determine independent prognostic factors in order to calculate the prognostic index (PI) and to establish a prognostic scoring system to identify patients most likely to benefit from surgery
Patients with stage III or IV colon cancer according to the classification of the International Union Against Cancer (UICC) normally received adjuvant chemotherapy after resection, but chemotherapy was not administered routinely before or after hepatic resection
Summary
Colorectal carcinoma (CRC) is a common malignancy of the digestive system and up to 50% of affected patients will develop metastases during the course of their disease [1,2]. Radical resection offers the only chance of long-term survival, with 30 to 40% of patients surviving 5 years. The prognosis for patients with liver metastases from CRC is still poor. Only 30 to 58% of patients who undergo a curative liver resection with complete extirpation of liver metastases are alive at 5 years [5,6]. The present study retrospectively analyzed 293 patients subjected to resection of liver metastases in the Department of Surgery, the First Hospital of China Medical University and Shen Zhou Hospital of Shen Yang Medical College, China, from January 1993 to January 2006. Several variables were analyzed by univariate and multivariate methods to determine independent prognostic factors in order to calculate the prognostic index (PI) and to establish a prognostic scoring system to identify patients most likely to benefit from surgery
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