SURVIVAL INVESTIGATION IN PATIENTS WITH COLORECTAL LIVER METASTASIS: A SINGLE-INSTITUTION ANALYSIS

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Abstract

Background

To investigate survival in patients with colorectal liver metastasis (CRLM) and identify risk factors associated with survival.

Methods

A total of 1613 consecutive patients with CRLM in Zhongshan Hospital between 2000 and 2010 were retrospectively analyzed. The prognostic value of different factors was studied through univariate and multivariate analyses.

Results

Synchronous liver metastasis (SLM), female, grade III–IV, T4 and N positive of primary tumor, bilobar disease, number of liver metastases ≥4, size of largest liver metastases ≥5 cm, CEA ≥5 ng/ml and CA19–9 ≥ 37 µg/ml were predictors of adverse outcome using univariate analysis. The median survival and 5-year survival rate for patients after resection of liver metastases was 49.8 months and 47%, better than that for those after other therapy. Expansion of the indications for liver resection, simultaneous or staged resection of primary tumor and liver metastases and preoperative neoadjuvant therapy had no effect on survival. Sixty-four initially unresectable patients underwent surgery after convertible therapy and demonstrated a median survival of 36.9 months and a 5-year survival of 30%, better than that of unresectable patients without surgery. By multivariate analysis, SLM, poorly differentiated primary tumor, number of liver metastases ≥4, size of largest liver metastases ≥5 cm, and no surgical treatment of liver metastases were found to be independent predictors. Assigning one point to each of above factors, the total was divided into six groups with distinct 5-year survival rates: 0 points (77%), 1 point (57%), 2 points (38%), 3 points (12%), 4 points (4%) and 5 points (0%) (P < 0.001).

Conclusions

Patients with CRLM could get long-term survival benefit from different types of therapy used to treat the liver metastases, and resection of resectable and initially unresectable liver metastases was the optimal strategy. Long-term survival outcome can be predicted from the above five factors.

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