Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model

Abstract

Objective: To determine the utility of hepatic resection (HR) in the treatment of patients with noncolorectal nonendocrine liver metastases (NCNELM).

Summary background data: The place of HR in the treatment of NCNELM remains controversial, primarily due to the limitations of previously published reports and the heterogeneity of primary tumor sites and histologies.

Methods: A multivariate risk model was developed by analyzing prognostic factors and long-term outcomes in 1452 patients with NCNELM treated with HR at 41 centers from 1983 to 2004.

Results: Hepatic metastases were solitary in 56% and unilateral in 71% (mean diameter, 50.5 mm). Extrahepatic metastases were present in 22%. The most common primary sites were breast (32%), gastrointestinal (16%), and urologic (14%). The most common histologies were adenocarcinoma (60%), GIST/sarcoma (13.5%), and melanoma (13%). R0 resection was achieved in 83% of patients with a 60-day mortality rate of 2.3% and a major complication rate of 21.5%. Tumor recurred in 67% of patients (liver, 24%; extrahepatic, 18%; both, 25%). Overall and disease-free survivals at 5 years were 36% and 21% and at 10 years were 23% and 15%, respectively. In multivariate analysis, factors associated with poor prognosis were patient age >60 years, nonbreast origin, melanoma or squamous histology, disease-free interval <12 months, extrahepatic metastases, R2 resection, and major hepatectomy (all P < or = 0.02). A prognostic model based on these factors effectively stratified patients into low-risk (0-3 points, 46% 5-year survival), mid-risk (4-6 points, 33% 5-year survival), and high-risk (>6 points, <10% 5-year survival) groups (P = 0.0001).

Discussion: HR for NCNELM is safe and effective, with outcomes mainly dependent on primary tumor site and histology. For individual patients, a statistical model based on key prognostic factors could validate the indication for hepatic resection by predicting long-term survivals.

FIGURE 1. Annual number of hepatic resections for patients with noncolorectal nonendocrine liver metastases at 41 centers from 1983 to 2004.

FIGURE 2. Survivals for study patients with noncolorectal nonendocrine liver metastases following hepatic resection. A, Overall survival. B, Recurrence-free survival. C, Disease-free survival.

FIGURE 3. Survivals for individual prognostic factors based on univariate and multivariate analysis. A, Age. B, Primary tumor site and histology. C, Disease-free interval from treatment of primary tumor to diagnosis of liver metastases. D, Extrahepatic disease. E, Resection margin. F, Repeat hepatectomy for hepatic recurrence.

FIGURE 4. Analysis of survivals based on a risk model for patients with noncolorectal nonendocrine liver metastases. Points assigned as follows: extrahepatic metastases present prior to or at the time of hepatectomy = 1 point; major hepatectomy (>2 segments) = 1 point; R2 resection = 1 point. Absence of these factors resulted in an assignment of 0 points for these categories. Patient age less than 30 years = 0 points; 30–60 years = 1 point; greater than 60 years = 2 points. Patient with a disease-free interval greater than 24 months = 0 points; 12–24 months = 1 point; less than 12 months = 2 points. Patient with breast primary tumor = 0 points; squamous primary tumor histology = 2 points; choroids melanoma primary tumor = 3 points; all other primary tumor sites and histologies = 1 point.