Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct;15(10):803-13.
doi: 10.1111/hpb.12136. Epub 2013 Jun 19.

Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis

Marcus C B Tan  1 , Jean M Butte, Mithat Gonen, Nancy Kemeny, Yuman Fong, Peter J Allen, T Peter Kingham, Ronald P Dematteo, William R Jarnagin, Michael I D'Angelica
Affiliations

Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis

Marcus C B Tan et al. HPB (Oxford). 2013 Oct.

Abstract

Background: For patients undergoing liver resection for colorectal metastases, specific clinico-pathological variables have been shown to be prognostic at baseline. This study analyses how the prognostic capability of these variables changes in a conditional survival model.

Methods: Retrospective review of a prospectively maintained database of patients who underwent an R0 resection of colorectal liver metastases from 1994 to 2004 at a single institution.

Results: In total, 807 patients were identified, with an 87-month median follow-up for survivors. Five- and 10-year disease-specific survivals (DSS) were 68% and 55%, respectively. The probability of further survival increased as the survival time increased. For 3-year survivors (n = 504), DSS were no longer significantly different between patients with a low (0-2) or high (3-5) clinical risk score (CRS, P = 0.19). On multivariate analysis, independent predictors of DSS for 3-year survivors were recurrence within the first 3 years after a liver resection, a pre-operative carcinoembryonic antigen (CEA) >200 ng/ml and disease-free interval <12 months prior to the diagnosis of liver metastasis. However, for those patients who were recurrence free at 1 year, no clinico-pathological variables retained prognostic significance.

Discussion: After 3 years of DSS and 1 year of recurrence-free survival, baseline clinico-pathological variables have a limited ability to predict future survival. Early post-operative recurrence appears to be the most useful single clinical feature in estimating conditional DSS.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Conditional disease-specific survival for all survivors (a); and recurrence-free survivors (b)
Figure 2
Figure 2
Disease-specific survival stratified by a low or high clinical risk score (CRS) at baseline (a), 1 year (b), 2 years (c) and 3 years (d) post-operatively
Figure 3
Figure 3
Disease-specific survival of patients who were recurrence free at 1 year post-operatively, stratified by low or high clinical risk score (CRS)
Figure 4
Figure 4
Disease-specific survival at 1 year post-operatively, stratified by recurrence within the first post-operative year
Figure 5
Figure 5
Disease-specific survival stratified by nomogram quartiles, at baseline
Figure 6
Figure 6
Disease-specific survival for recurrence-free survivors at 1 year (a) and 2 years (b) post-operatively, stratified by nomogram quartiles
See this image and copyright information in PMC

References

    1. House MG, Ito H, Gonen M, Fong Y, Allen PJ, DeMatteo RP, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210:744–752. 52–5. - PubMed
    1. Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575–4580. - PubMed
    1. D'Angelica M, Kornprat P, Gonen M, DeMatteo RP, Fong Y, Blumgart LH, et al. Effect on outcome of recurrence patterns after hepatectomy for colorectal metastases. Ann Surg Oncol. 2011;18:1096–1103. - PubMed
    1. Ambiru S, Miyazaki M, Isono T, Ito H, Nakagawa K, Shimizu H, et al. Hepatic resection for colorectal metastases: analysis of prognostic factors. Dis Colon Rectum. 1999;42:632–639. - PubMed
    1. Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235:759–766. - PMC - PubMed

MeSH terms