Evaluation of Outcomes and Treatment Safety of Patients with Metastatic Colorectal Cancer to the Liver with Estimation of Prognostic Factors
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Liver resection is essential part of colorectal cancer liver metastases (CLM) treatment. Mean 5-year overall survival after resection achieves 30-45%. There are many factors influencing long-term outcomes, and among them the inflammatory response to tumor plays an important role.The aim of the study was evaluation of outcomes and treatment safety of patients with metastatic colorectal cancer to the liver with estimation of prognostic factors.Material and methods. 130 consecutive patients (70 men and 60 women) operated in MSC Institute and Cancer Center in Gliwice from 2001 to 2009 due to colorectal liver metastases were analysed. Age of the patients ranged from 33 to 82 years (median 60 years). 96 (74%) patients underwent potentially radical resection, and in remaining 34 (26%) was performed radiofrequency ablation (RFA) alone or combined with the resection. In the resection group 37 right hepatectomies, 11 left hepatectomies, 28 segmentectomies and 20 metastasectomies were performed. Disease-free survival (DFS) and overall survival (OS) were statistically analysed using the Kaplan-Meier method. Factors determining DFS and OS were analysed using Cox regression model.Results. In the resection group the 3- and 5-years OS was 64,5% and 46,6% respectively, and the 3- and 5-years DFS was 32% and 30,5% respectively. In the RFA group the 3- and 5-years OS was 33% and 9,5%. Statistically significant prognostic factors in the resection group in uni- and multivariate analysis were: grade and nodal involvement of the primary tumor, diameter of metastatic focus, positive and narrow (<1 mm) resection margins, preoperative fibrinogen level, preoperative neutrophil to lymphocyte ratio and leukocyte amount of the peripheral blood. The perioperative mortality rate was 3%.Conclusions. Liver resection due to colorectal liver metastases is a safe and effective method resulting in high survival rates. We confirmed some generally accepted prognostic factors influencing longterm outcomes and shown the impact of inflammatory response. We also confirmed the hypothesis that preoperative plasma fibrinogen level influences outcomes after liver resection due to CLM.
1 - 06 - 2013
05 - 07 - 2013
- 1. Simmonds PC, Primrose JM, Colquitt JL et al.: Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006; 94: 982-99.[Crossref]
- 2. Neal CP, Mann CD, Garcea G et al.: Preoperative systemic inflammation and infectious complications after resection of colorectal liver metastases. Arch Surg 2011; 146(4): 471-78.[WoS]
- 3. Malik HZ, Prasad KR, Halazun KJ et al.: Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases. Ann Surg 2007; 246: 806-14.[WoS]
- 4. Fong Y, Fortner J, Sun RL et al.: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Ann Surg 1999; 230(3): 309-21.
- 5. Hohenberger P, Schlag PM, Gerneth T et al.: Pre- and postoperative carcinoembryonic antigen determinations in hepatic resection for colorectal metastases. Ann Surg 1994; 219(2): 135-43.
- 6. Kanazawa A, Shiozawa M, Inagaki D et al.: Risk factors for intrahepatic recurrence after curative surgical treatment of colorectal liver metastases. Hepato-Gastoenterology 2010; 57: 1183-86.
- 7. Balkwill F, Mantovani A: Inflammation and cancer: back to Virchow? Lancet 2001; 357(9255): 539-45.
- 8. Zahorec R: Ratio of neutrophil lymphocyte counts- rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl LekListy 2001; 102: 5-14.
- 9. Martini WZ: Fibrinogen metabolic responses to trauma. Scand J Trauma Resusc Emerg Med 2009; 17: 2.[Crossref][PubMed]
- 10. Zeman M, Kryj M, Czarnecki M i wsp.: Chirurgiczne leczenie przerzutów raka jelita grubego do wątroby - doświadczenia własne. Nowotwory 2012; 62(1): 5-9.
- 11. Coussens LM, Werb Z: Inflammation and cancer. Nature 2002; 420: 860-67.
- 12. Katz SC, Bamboat ZM, Maker AV et al.: Regulatory T-cell infiltration predicts outcome following resection of colorectal cancer liver metastases. AnnSurg Oncol 2013; 20(3): 946-55.
- 13. Okano K, Maeba T, Moroguchi A et al.: Lymphocytic infiltration Surrounding Liver metastases from colorectal cancer. J Surg Oncol 2003; 82: 28-33.
- 14. Halazun KJ, Aldoori A, Malik HZ et al.: Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 2008; 34: 55-60.[PubMed][Crossref][WoS]
- 15. Seebacher V, Polterauer S, Grimm C et al.: The prognostic value of plasma fibrinogen levels in patients with endometrial cancer: a multi-centre trial. Br J Cancer 2010; 102: 952-56.[Crossref]
- 16. Jones JM, McGinigle NC, McAnespie M et al.: Plasma fibrinogen and serum C-reactive protein are associated with non-small cell lung cancer. Lung Cancer 2006; 53: 97-101.[WoS]
- 17. Yamashita H, Kitayama J, Nagawa H: Hyperfibrinogenemia is a useful predictor for lymphatic metastasis in human gastric cancer. Jpn J ClinOncol 2005; 35(10): 595-600.
- 18. Yamashita H, Kitayama J, Taguri M et al.: Effect of preoperative hyperfibrinogenemia on recurrence of colorectal cancer without a systemic inflammatory response. World J Surg 2009; 33: 1298-1305.[WoS]
- 19. Cady B, Jenkins RL, Steele GD et al.: Surgical margin in hepatic resection for colorectal metastasis, a critical and imrovable determinant of outcome. Ann Surg 1998; 227(4): 566-71.
- 20. Kokudo N, Miki Y, Sugai S et al.: Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma. Arch Surg 2002; 137: 833-40.
- 21. de Haas RJ, Wicherts DA, Flores E et al.: R1 resection by necessity for colorectal liver metastases, is it still a contraindication to surgery? AnnSurg 2008; 248: 626-37.
- 22. Pawlik TM, Scoggins CR, Zorzi D et al.: Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005; 241: 715-24.
- 23. Figueras J, Burdio F, Ramos E et al.: Effect of subcentimeter nonpositive resection margin on hepatic recurrence In patients undergoing hepatectomy for colorectal lever metastases. Evidences from 663 liver resections. Ann Oncol 2007; 18: 1190-95.[WoS]
- 24. Arru M, Aldrighetti L, Castoldi R et al.: Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg 2008; 32: 93-103.[WoS]
- 25. Bakalakos EA, Kim JA, Young DC et al.: Determinants of survival following hepatic resection for metastatic colorectal cancer. World J Surg 1998; 22: 399-405.[PubMed][Crossref]
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