Colorectal cancer liver metastases - a population-based study on incidence, management and survival

Abstract

Background: Colorectal cancer (CRC) is a leading cause of cancer-associated deaths with liver metastases developing in 25-30% of those affected. Previous data suggest a survival difference between right- and left-sided liver metastatic CRC, even though left-sided cancer has a higher incidence of liver metastases. The aim of the study was to describe the liver metastatic patterns and survival as a function of the characteristics of the primary tumour and different combinations of metastatic disease.

Methods: A retrospective population-based study was performed on a cohort of patients diagnosed with CRC in the region of Stockholm, Sweden during 2008. Patients were identified through the Swedish National Quality Registry for Colorectal Cancer Treatment (SCRCR) and additional information on intra- and extra-hepatic metastatic pattern and treatment were retrieved from electronic patient records. Patients were followed for 5 years or until death. Factors influencing overall survival (OS) were investigated by means of Cox regression. OS was compared using Kaplan-Meier estimations and the log-rank test.

Results: Liver metastases were diagnosed in 272/1026 (26.5%) patients within five years of diagnosis of the primary. Liver and lung metastases were more often diagnosed in left-sided colon cancer compared to right-sided cancer (28.4% versus 22.1%, p = 0.029 and 19.7% versus 13.2%, p = 0.010, respectively) but the extent of liver metastases were more extensive for right-sided cancer as compared to left-sided (p = 0.001). Liver metastatic left-sided cancer, including rectal cancer, was associated with a 44% decreased mortality risk compared to right-sided cancer (HR = 0.56, 95% CI: 0.39-0.79) with a 5-year OS of 16.6% versus 4.3% (p < 0.001). In liver metastatic CRC, the presence of lung metastases did not significantly influence OS as assessed by multivariate analysis (HR = 1.11, 95% CI: 0.80-1.53).

Conclusion: The worse survival in liver metastatic right-sided colon cancer could possibly be explained by the higher number of metastases, as well as more extensive segmental involvement compared with left-sided colon and rectal cancer, even though the latter had a higher incidence of liver metastases. Detailed population-based data on the metastatic pattern of CRC and survival could assist in more structured and individualized guidelines for follow-up of patients with CRC.

Keywords: Colorectal cancer; Extra-hepatic metastases; Left-sided cancer; Liver metastases; Right-sided cancer; Survival.

Fig. 1

The cumulative incidence of liver metastases (a) and lung metastases (b) as related to the time of diagnosis of the primary tumour. CRC (colorectal cancer)

Fig. 2

Kaplan-Meier estimates showing overall survival in patients with non-metastatic CRC and different metastatic pattern. Liver and lung metastases versus liver-only metastases, median survival 1.8 years and 1.4 years, respectively, p = 0.204 (log rank test). Liver-only metastases versus lung only metastases, median survival 1.4 years and 4.3 years, respectively, p = 0.006 (log-rank test). Lung only metastases versus non-metastatic CRC p < 0.001, (log-rank test). CRC (colorectal cancer)

Fig. 3

Kaplan-Meier estimates showing overall survival in patients with liver metastases treated with curative intended intervention, palliative chemotherapy or BSC (no chemotherapy). BSC versus palliative chemotherapy (median survival 0.24 years versus 1.2 years) p < 0.001 (log-rank test), palliative chemotherapy versus curative intended interventions (median survival 1.2 years versus 4.7 years), p < 0.001 (log-rank test). BSC (best supportive care)

Fig. 4

Kaplan-Meier estimates showing overall survival in patients with liver metastatic right-sided and left-sided colon and rectal cancer. Left-sided versus right-sided cancer with liver metastases (median survival 17.7 versus 6.7 months) (p < 0.001) (log-rank test). LM (liver metastases)

Fig. 5

Kaplan-Meier estimates showing overall survival in patients with right-sided or left-sided colon and rectal cancer undergoing liver resection or not. Resected liver metastatic left-sided versus right-sided cancer (p = 0.012). Non-resected liver metastatic left-sided versus right-sided cancer (p = 0.007). LM (liver metastases)