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. 2025 Feb;32(2):1083-1092.
doi: 10.1245/s10434-024-16386-3. Epub 2024 Nov 4.

The Value of Primary Tumor Resection in Patients with Liver Metastases: A 10-Year Outcome

Lin-Lin Liu #  1 , Yu-Kun Lin #  1 , Zuo-Lin Xiang  2
Affiliations

The Value of Primary Tumor Resection in Patients with Liver Metastases: A 10-Year Outcome

Lin-Lin Liu et al. Ann Surg Oncol. 2025 Feb.

Abstract

Objective: This study aimed to analyze the impact of primary tumor resection (PTR) on the prognosis of four common primary tumors with liver metastases, and to develop a prognostic model to visualize the PTR benefit rate of patients with liver metastases.

Materials and methods: Patients diagnosed with colorectal cancer liver metastases (CRLM), pancreatic cancer liver metastases (PLM), gastric cancer liver metastases (GLM), and breast cancer liver metastases (BLM) between 2004 and 2015 were retrospectively reviewed from the Surveillance, Epidemiology, and End Results (SEER) database and assigned to either the surgery or non-surgery groups. A 1:1 propensity score matching (PSM) was performed. Surgical patients who survived longer than the median cancer-specific survival (CSS) time for non-surgery patients constituted the benefit group. Logistic regression was conducted to explore the independent factors affecting surgical benefit, and a nomogram was established.

Results: A total of 21,928 patients with liver metastases were included. After PSM for surgery and non-surgery patients, we found that PTR had a significant impact on the overall survival (OS) and CSS of CRLM, PLM, and BLM patients. In CRLM patients, age (p < 0.001), primary site (p = 0.006), grade (p = 0.009), N stage (p = 0.034), and histology (p = 0.006) affected the surgical benefit. In BLM patients, the independent factors were age (p = 0.002), race (p = 0.020), and radiotherapy (p = 0.043). And in PLM patients, chemotherapy was an independent factor associated with a survival benefit from PTR.

Conclusion: PTR improved OS and CSS in patients with CRLM, PLM, and BLM. A predictive model was established to identify suitable candidates for PTR in CRLM patients.

Keywords: Liver metastases; Nomogram; Primary tumor resection; SEER.

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Conflict of interest statement

Ethics Approval and Consent to Participate: All participants from our center signed written informed consent. The study protocol conformed to the ethical guidelines of the Declaration of Helsinki and was approved by the Ethical Committee at Shanghai East Hospital. Disclosure: Lin-Lin Liu, Yu-Kun Lin, and Zuo-Lin Xiang declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Study selection process. SEER Surveillance, Epidemiology, and End Results
Fig. 2
Fig. 2
Cancer-specific survival plots of (A) CRLM, (B) PLM, (C) GLM, and (D) BLM patients, according to treatment after PSM. CRLM colorectal cancer liver metastases, PLM pancreatic cancer liver metastases, GLM gastric cancer liver metastases, BLM breast cancer liver metastases, PSM propensity score matching
Fig. 3
Fig. 3
Cancer-specific survival plots of (A) CRLM, (B) PLM, and (C) BLM patients, according to age and treatment after PSM. CRLM colorectal cancer liver metastases, PLM pancreatic cancer liver metastases, BLM breast cancer liver metastases, PSM propensity score matching
Fig. 4
Fig. 4
A nomogram was used to identify patients who would benefit from PTR in CRLM. The corresponding scores for each variable were summed to obtain a total score, which was then used to calculate the likelihood of receiving a benefit. Patients with a benefit likelihood of >0.5 were recommended for PTR
See this image and copyright information in PMC

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