BACKGROUND: Hepatic resection of colorectal liver metastases is associated with long-term survival. This study analyzes actual 10-year survivors after resection of colorectal liver metastases, reports the observed rate of cure, and identifies factors that preclude cure. METHODS: A single-institution, prospectively maintained database was queried for all initial resections for colorectal liver metastases for the years 1992-2004. Observed cure was defined as actual 10-year survival with either no recurrence or resected recurrence with at least 3 years of disease-free follow-up. Clinical risk score was dichotomized into low (0-2) and high (3-5). Semiparametric proportional hazards mixture cure model was utilized to estimate probability of cure. RESULTS: We included 1,211 patients with a median follow-up for survivors of 11 years. Median disease-specific survival was 4.9 years (95% CI: 4.4-5.3). 295 patients (24.4%) were actual 10-year survivors. The observed cure rate was 20.6% (n = 250). Among 250 cured patients, 192 (76.8%) had no recurrence and 58 (23.2%) had a resected recurrence with at least 3 years of disease-free follow-up. Extrahepatic disease (n = 88), carcinoembryonic antigen >200 ng/mL (n = 119), positive margin (n = 109), and >10 tumors (n = 31) had observed cure rates less than 10%. In cure model analysis, patients with both extrahepatic disease and high clinical risk score (n = 31) had an estimated probability of cure of 3.5%. CONCLUSION: Actual 10-year survival after resection of colorectal liver metastases is 24% with an observed 20% cure rate. Patients with both high clinical risk score and extrahepatic disease have an estimated probability of cure less than 5%. When such factors are identified, strong consideration may be given to preoperative strategies, such as neoadjuvant chemotherapy, to help select patients for surgical therapy.
BACKGROUND: Hepatic resection of colorectal liver metastases is associated with long-term survival. This study analyzes actual 10-year survivors after resection of colorectal liver metastases, reports the observed rate of cure, and identifies factors that preclude cure. METHODS: A single-institution, prospectively maintained database was queried for all initial resections for colorectal liver metastases for the years 1992-2004. Observed cure was defined as actual 10-year survival with either no recurrence or resected recurrence with at least 3 years of disease-free follow-up. Clinical risk score was dichotomized into low (0-2) and high (3-5). Semiparametric proportional hazards mixture cure model was utilized to estimate probability of cure. RESULTS: We included 1,211 patients with a median follow-up for survivors of 11 years. Median disease-specific survival was 4.9 years (95% CI: 4.4-5.3). 295 patients (24.4%) were actual 10-year survivors. The observed cure rate was 20.6% (n = 250). Among 250 cured patients, 192 (76.8%) had no recurrence and 58 (23.2%) had a resected recurrence with at least 3 years of disease-free follow-up. Extrahepatic disease (n = 88), carcinoembryonic antigen >200 ng/mL (n = 119), positive margin (n = 109), and >10 tumors (n = 31) had observed cure rates less than 10%. In cure model analysis, patients with both extrahepatic disease and high clinical risk score (n = 31) had an estimated probability of cure of 3.5%. CONCLUSION: Actual 10-year survival after resection of colorectal liver metastases is 24% with an observed 20% cure rate. Patients with both high clinical risk score and extrahepatic disease have an estimated probability of cure less than 5%. When such factors are identified, strong consideration may be given to preoperative strategies, such as neoadjuvant chemotherapy, to help select patients for surgical therapy.
Authors: Karen Bolhuis; G Emerens Wensink; Marloes A G Elferink; Marinde J G Bond; Willemieke P M Dijksterhuis; Remond J A Fijneman; Onno W Kranenburg; Inne H M Borel Rinkes; Miriam Koopman; Rutger-Jan Swijnenburg; Geraldine R Vink; Jeroen Hagendoorn; Cornelis J A Punt; Sjoerd G Elias; Jeanine M L Roodhart Journal: Cancers (Basel) Date: 2022-05-10 Impact factor: 6.575
Authors: Vladislav Treska; Martin Skala; Kristyna Prochazkova; Aneta Svejdova; Tereza Petrakova; Jakub Sebek; Ivan Riha; Jachym Rosendorf; Robert Polak; Tomas Skalicky; Vaclav Liska Journal: In Vivo Date: 2020 Sep-Oct Impact factor: 2.155
Authors: Lily V Saadat; Thomas Boerner; Debra A Goldman; Mithat Gonen; Timothy L Frankel; Efsevia Vakiani; T Peter Kingham; William R Jarnagin; Alice C Wei; Kevin C Soares; David B Solit; Michael I D'Angelica Journal: Ann Surg Oncol Date: 2020-07-18 Impact factor: 5.344
Authors: I Kurilova; A Bendet; E K Fung; E N Petre; J L Humm; F E Boas; C H Crane; N Kemeny; T P Kingham; A Cercek; M I D'Angelica; R G H Beets-Tan; C T Sofocleous Journal: Abdom Radiol (NY) Date: 2021-02-19