Predictors of cure after hepatic resection of colorectal liver metastases: an analysis of actual 5- and 10-year survivors.

BACKGROUND: Hepatic resection of colorectal liver metastases (CLM) is now regarded the standard of care. Evaluation of true long-term survivors will demonstrate the curative potential of this therapy with cure being defined as actual 10-year survival versus a satisfactory oncological outcome of 5-year survival. Limited data exists on outcomes of patients beyond 5 years. Studying the rates of cure and predictive factors for cure are essential to define the true benefit of this therapy.
METHODS: Retrospective review of a prospectively maintained hepatobiliary surgical database was performed on patients who underwent hepatic resection of CLM between 1991 and 2005 with a minimum of 5-year follow-up. Survival was calculated from the time of surgery using the Kaplan-Meier method.
RESULTS: There were 455 consecutive patients with a minimum of 5-year follow-up. The actuarial median overall survival was 33 months (95% CI, 29-37%), actuarial 5-, and 10-year survival rates were 34% and 25%, respectively. Hundred twenty four patients were identified as actual 5-year survivors (27%) with their actuarial median overall survival being 11.1 years, actuarial 10-year survival rate of 59%, and a median disease-free survival of 4.9 years. Patients requiring subsequent treatment of modern systemic chemotherapy for post-resection recurrence (P = 0.003) was a negative predictors of cure from multivariate analysis.
CONCLUSION: This study demonstrate that approximately one in three patients undergoing resection for CLM will become actual 5-year survivors from which approximately half will go on to survive 10-years and be cured of CLM.