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Clinical Trial
. 2013 Sep 17;109(6):1428-36.
doi: 10.1038/bjc.2013.475. Epub 2013 Aug 20.

Evaluation of prognostic factors in liver-limited metastatic colorectal cancer: a preplanned analysis of the FIRE-1 trial

C Giessen  1 , L Fischer von Weikersthal, R P Laubender, S Stintzing, D P Modest, A Schalhorn, C Schulz, V Heinemann
Affiliations
Clinical Trial

Evaluation of prognostic factors in liver-limited metastatic colorectal cancer: a preplanned analysis of the FIRE-1 trial

C Giessen et al. Br J Cancer. .

Abstract

Background: Liver-limited disease (LLD) denotes a specific subgroup of metastatic colorectal cancer (mCRC) patients.

Patients and methods: A total of 479 patients with unresectable mCRC from an irinotecan-based randomised phase III trial were evaluated. Patients with LLD and non-LLD and hepatic resection were differentiated. Based on baseline patient characteristic, prognostic factors for hepatic resection were evaluated. Furthermore, prognostic factors for median overall survival (OS) were estimated via Cox regression in LLD patients.

Results: Secondary liver resection was performed in 38 out of 479 patients (resection rate: 7.9%). Prognostic factors for hepatic resection were LLD, lactate dehydrogenase (LDH), node-negative primary, alkaline phosphatase (AP) and Karnofsky performance status (PS). Median OS was significantly increased after hepatic resection (48 months), whereas OS in LLD (17 months) and non-LLD (19 months) was comparable in non-resected patients. With the inapplicability of Koehne's risk classification in LLD patients, a new score based on only the independent prognostic factors LDH and white blood cell (WBC) provided markedly improved information on the outcome.

Conclusion: Patients undergoing hepatic resection showed favourable long-term survival, whereas non-resected LLD patients and non-LLD patients did not differ with regard to progression-free survival and OS. The LDH levels and WBC count were confirmed as prognostic factors and provide a useful and simple score for OS-related risk stratification also in LLD.

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Figures

Figure 1
Figure 1
(A) Progression-free survival in patients who underwent liver resection, LLD and non-LLD. (B) Overall survival in patients underwent liver resection, LLD and non-LLD. Abbreviations: LR=liver resection; LLD=liver-limited disease; non-LLD=non-liver-limited disease; OS=overall survival; PFS=progression-free survival.
Figure 2
Figure 2
(A) Overall survival in patients according to Köhne's risk classification (FIRE-1 trial population; n=479). (B) Overall survival according to FIRE prognostic score (LDH + WBC) (LLD population). (C) Overall survival according to FIRE prognostic score (LDH + WBC) (FIRE-1 trial population). Abbreviations: Low risk=WBC count and LDH levels not elevated; Intermediate risk=WBC count or LDH levels elevated; High risk=WBC count and LDH levels elevated; OS=overall survival.
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