Prediction of Survival in Patients with Unresectable Colorectal Liver Metastases
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Liver metastases are diagnosed synchronously with the primary tumour in 25% of patients with colorectal cancer. A half of the remaining patients develop liver metastases within 3 years following colectomy. At present, the only radical treatment of metastases is liver resection. Only 2.6% of patients survive 3 years if such treatment is not implemented. The aim of the study was to assess predictive factors of long-term survival in the group of patients with unresectable colorectal liver metastases carcinoma. Material and methods. Of 1029 patients with colorectal liver metastases, who were treated in the Department of General, Transplant and Liver Surgery of the Medical University of Warsaw in the years 2006-2012, cases of liver metastases assessed intraoperatively as unresectable were selected. The retrospective analysis included 85 patients. Based on the medical documentation, information concerning age, sex, characteristics of primary and secondary tumours, reasons for unresectability, neoadjuvant chemotherapy as well as local treatment of liver tumours was collected. Preoperative serum concentrations of CEA and CA 19-9 markers were considered. The Cox regression model, Kaplan- Meier estimator and log-rank test were applied in the statistical analyses. Results. The most common reason for unresectability were: number of metastases in 31 patients (36.5%) and extrahepatic metastases in 19 cases (22.4%). Overall survival in the entire group was 56.1% and 15.5% after 1 and 3 years respectively. A single-factor analysis showed that CEA serum levels (p=0.032; HR=1.002 per increase by 1 ng/ml) and the presence of extrahepatic metastases (p=0.037; HR=2.06) were predictors of worse survival. In a multivariate analysis, CEA concentration (p=0.017; HR=1.002 per increase by 1 ng/ml) was an independent predictor of death whereas the presence of extrahepatic metastases were not statistically significant (p=0.059; HR=2.09). Conclusions. Serum concentration of CEA marker is an independent predictor of worse survival, but the presence of extrahepatic metastases shows a similar tendency
1 - 7 - 2014
12 - 9 - 2014
- 1. Fong Y, Fortner J, Sun RL et al.: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230: 309-18.
- 2. Manfredi S, Lepage C, Hatem C et al.: Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 2006; 244: 254-59.
- 3. Adam R, Delvart V, Pascal G et al.: Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004; 240: 644-57.
- 4. Stangl R, Altendorf-Hofmann A, Charnley RM et al.: Factors influencing the natural history of colorectal liver metastases. Lancet 1994; 16: 132-37.
- 5. Abdalla EK, Vauthey J-N, Ellis LM et al.: Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-27.
- 6. Ferrarotto R, Pathak P, Maru D et al.: Durable complete responses in metastatic colorectal cancer treatedwith chemotherapy alone. Clin Colorectal Cancer 2011; 10: 178-82.
- 7. Gillams AR, Lees WR. Radiofrequency ablation of colorectal liver metastases. Abdom Imaging 2005; 30: 419-26.
- 8. Lim L, Gibbs P, Yip D et al.: A prospective evaluation of treatment with selective internal radiation therapy (SIR-spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy. BMC Cancer 2005; 5: 132-37.
- 9. Yoon YS , Kim CW , Lim SB et al.: Palliative surgery in patients with unresectable colorectal liver metastases: a propensity score matching analysis. J Surg Oncol 2014; 109: 239-44.
- 10. Iwatsuki S, Dvorchik I, Madariaga JR et al.: Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg 1999; 189: 291-99.
- 11. Mann CD, Metcalfe MS, Leopardi LN et al.: The clinical risk score: emerging as a reliable preoperative prognostic index in hepatectomy for colorectal metastases. Arch Surg 2004; 139: 1168-72.
- 12. Rees M, Tekkis PP, Welsh FK et al.: Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 2008; 247: 125-35.
- 13. John SK , Robinson SM, Rehman S et al.: Prognostic factors and survival after resection of colorectal liver metastasis in the era of preoperative chemotherapy: an 11-year single-centre study. Dig Surg 2013; 30: 293-301.
- 14. Charnsangavej C, Clary B, Fong Y et al.: Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13: 1261-68.
- 15. Nordlinger B, Sorbye H, Glimelius B et al.: Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 2008; 371: 1007-16.[WoS]
- 16. Pfannschmidt J, Dienemann H, Hoffmann H. Surgical resection of pulmonary metastases from
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