Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET)

Abstract

Objective: To report the first 5-year overall survival results in patients with colorectal carcinoma metastatic to the liver who have undergone hepatic resection after staging with [18F] fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET).

Summary background data: The 5-year overall survival after hepatic resection for colorectal cancer metastases without preoperative FDG-PET has been established in 19 studies (6070 patients). The median 5-year overall survival rate in these studies is 30% and has not improved over time. FDG-PET detects unsuspected tumor in 25% of patients considered to have resectable hepatic metastasis by conventional staging.

Methods: From March 1995 to June 2002, all patients having hepatic resection for colorectal cancer metastases had preoperative FDG-PET. A prospective database was maintained.

Results: One hundred patients (56 men, 44 women) were studied. Metastases were synchronous in 52, single in 63, unilateral in 78, and <5 cm in diameter in 60. Resections were major (>3 segments) in 75 and resection margins were > or = 1 cm in 52. Median follow up was 31 months, with 12 actual greater than 5-year survivors. There was 1 postoperative death. The actuarial 5-year overall survival was 58% (95% confidence interval, 46-72%). Primary tumor grade was the only prognostic variable significantly correlated with overall survival.

Conclusions: Screening by FDG-PET is associated with excellent postresection 5-year overall survival for patients undergoing resection of hepatic metastases from colorectal cancer. FDG-PET appears to define a new cohort of patients in whom tumor grade is a very important prognostic variable.

FIGURE 1. Actuarial overall survival (OS, solid line) and disease-free survival (DFS, broken line) after hepatic resection for colorectal liver metastases in patients staged with FDG-PET.

FIGURE 2. Actuarial overall survival for 13 published series not using FDG-PET staging in comparison to overall survival in this series.

FIGURE 3. Effect of grade of primary tumor: (A) Actuarial overall survival in patients with well and moderately differentiated primary tumors (solid line) versus poorly differentiated primary tumors (broken line). (B) Actuarial disease-free survival in patients with well and moderately differentiated primary tumors (solid line) versus poorly differentiated primary tumors (broken line).

FIGURE 4. Effect of lymph node positivity in primary tumor specimen: (A) Actuarial overall survival in patients without (solid line) and with (broken line) positive lymph nodes. (B) Actuarial disease-free survival in patients without (solid line) and with (broken line) positive lymph nodes.