Abstract
BackgroundLocal treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence.MethodsData were collected retrospectively from CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram predicting overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curve.ResultsAmong 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated and had resectable and liver-limited disease. Among them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients received only systemic chemotherapy. Multivariable analysis identified primary lymph node positivity, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment as independent risk factors for survival outcomes. Integrating these five variables, the nomogram presented a good concordance index of 0.707. Compared with patients who received only systemic chemotherapy, radical local treatment did not significantly improve survival outcomes (median OS: 21 vs. 15 months, p = 0.126) in the high-risk group (total score ≥ 13).ConclusionRadical local treatment improved the survival of recurrent CRLM patients. The proposed model facilitates personalized assessments of prognosis for patients who develop first recurrence in the liver.
Highlights
Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM)
The present study created a nomogram to select recurrent CRLM patients who would benefit from repeat local treatment
More than half of CRLM patients recur after hepatic resection, and the majority of such recurrences occur within 2 years [3]
Summary
Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence. Hepatic resection is a potentially curative treatment for colorectal cancer liver metastasis (CRLM) patients with 5-year survival rates of 30–50% [2]. Recent advances in surgical approaches have dramatically changed the treatment strategy for recurrent CRLM patients, which has allowed the description of risk factors for survival after a second round of local treatment. Previous studies have provided evidence that repeat hepatic resection is feasible in selected patients with intrahepatic recurrence [4, 5]. Which individuals would yield maximum benefit from aggressive treatment following first recurrence is not clear, as there is a paucity of data on the risk factors for survival in this patient population. There has been no consensus introduced on how to select candidates
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