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. 2014 May 21:12:155.
doi: 10.1186/1477-7819-12-155.

Prognostic significance of the number of tumors and aggressive surgical approach in colorectal cancer hepatic metastasis

Kun-Ming Chan  1 , Tsung-Han Wu, Chih-Hsien Cheng, Wei-Chen Lee, Jy-Ming Chiang, Jinn-Shiun Chen, Jeng-Yi Wang
Affiliations

Prognostic significance of the number of tumors and aggressive surgical approach in colorectal cancer hepatic metastasis

Kun-Ming Chan et al. World J Surg Oncol. .

Abstract

Background: Although liver resection (LR) for colorectal cancer (CRC) hepatic metastasis is the best strategy to improve patient outcomes, there are considerable concerns regarding the recurrence of CRC after LR. In this study, we investigated the prognostic indicators associated with CRC recurrence after LR for hepatic metastasis.

Methods: This is a retrospective review of patients who underwent curative LR for CRC hepatic metastasis between January 2008 and December 2012. The clinicopathological features and outcome parameters affecting prognosis were analyzed.

Results: A total of 332 LRs with curative intent were performed in 278 patients, of whom 168 (60.4%) experienced CRC recurrence after the first LR, and 206 of the 332 LRs (62.0%) developed CRC recurrence. A preoperative serum carcinoembryonic antigen level greater than 100 ng/mL and four or more metastatic tumor nodules were independent prognostic factors for CRC recurrence after LR. The disease-free survival rate after LR was significantly associated with the number of metastatic nodules. The patients who underwent surgical resection for recurrent CRC had favorable outcomes, with a five-year overall survival rate of 65.2%.

Conclusion: The number of metastatic tumors significantly affects the outcomes of patients who undergo LR for CRC hepatic metastasis, indicating that a novel therapeutic strategy for patients at high risk may be required. However, favorable long-term outcomes are achievable through aggressive treatment with surgical resection of the recurrent CRC.

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Figures

Figure 1
Figure 1
The final status of the patients related to the number of liver resections.
Figure 2
Figure 2
Kaplan-Meier cumulative survival curves of the patients who underwent liver resection (LR) for colorectal cancer (CRC) hepatic metastasis by recurrence-free survival (RFS) and overall survival (OS).
Figure 3
Figure 3
Kaplan-Meier survival curves of the patients with colorectal cancer (CRC) recurrence after liver resection. A. The patients who underwent surgical resection for CRC recurrence had a significantly better survival curve than those who did not undergo surgical resection for CRC recurrence. The three-year survival rates after CRC recurrence were 60.0% and 16.8% for the patients who did and did not undergo surgical resection of recurrent CRC, respectively (P <0.0001). B. The cumulative overall survival rates calculated from the first liver resection showed significant survival benefits for the patients who underwent surgical resection for CRC recurrence. The five-year overall survival rates were 65.2% and 16.0%, respectively (P <0.0001).
Figure 4
Figure 4
The recurrence-free survival (RFS) curves of the patients after liver resection in terms of the number of hepatic metastatic tumors. The patients with solitary metastatic tumors had the best RFS curve, and the RFS curves became worse as the number of tumor nodules increased (P = 0.002).
See this image and copyright information in PMC

References

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