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Outcomes of resection for colorectal cancer hepatic metastases stratified by evolving eras of treatment.

Chan KM, Chiang JM, Lee CF, Yu MC, Lee WC, Chen JS, Wang JY - World J Surg Oncol (2011)

Bottom Line: Analysis of recurrence-free and overall survival rates also showed that the patient outcome was significantly better in the post-2003 era than in the pre-2003 era.Further analysis showed that a significantly higher percentage of patients in era 2 had received modern chemotherapeutic regimens including irinotecan and oxaliplatin, while patients in era 1 were mainly administered fluorouracil and leucovorin for adjuvant chemotherapy.However, the management and outcomes of patients with CRC hepatic metastasis have greatly improved with time, suggesting that the current use of aggressive multimodality treatments including surgical resection combined with modern chemotherapeutic regimens effectively prolongs the life expectancy of these patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan. chankunming@adm.cgmh.org.tw

ABSTRACT

Background and purpose: The outcomes and management of colorectal cancer (CRC) hepatic metastasis have undergone many evolutionary changes. In this study, we aimed to analyze the outcomes of patients with CRC hepatic metastasis in terms of the era of treatment.

Methods: We conducted a retrospective review of 279 patients who underwent liver resection (LR) for CRC hepatic metastases. The prognoses of patients treated pre-2003 (era 1) and post-2003 (era 2) were examined.

Results: Of the patients included in the study, 210 (75.3%) had CRC recurrence after LR. There was a significant difference in the ratio of CRC recurrence between the 2 eras (82.0% in era 1 vs. 69.5% in era 2; p = 0.008). Analysis of recurrence-free and overall survival rates also showed that the patient outcome was significantly better in the post-2003 era than in the pre-2003 era. Further analysis showed that a significantly higher percentage of patients in era 2 had received modern chemotherapeutic regimens including irinotecan and oxaliplatin, while patients in era 1 were mainly administered fluorouracil and leucovorin for adjuvant chemotherapy. Among patients with CRC recurrence, a significant ratio of those in era 2 underwent surgical resection for recurrent lesions, and these patients had a better survival curve than did patients without resection (34.1% vs. 2.2% for 5-year survival; p < 0.0001).

Conclusion: The incidence of CRC recurrence after LR for hepatic metastasis remains very high. However, the management and outcomes of patients with CRC hepatic metastasis have greatly improved with time, suggesting that the current use of aggressive multimodality treatments including surgical resection combined with modern chemotherapeutic regimens effectively prolongs the life expectancy of these patients.

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Cumulative survival curves of patients who underwent liver resection for hepatic metastasis according to the era of their treatment. A. The recurrence-free survival (RFS) rates in era 2 were significantly better than the RFS rates in era 1 (p = 0.013). B. The overall survival (OS) rate in era 2 was better than the OS rate in era 1 (p < 0.0001).
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Figure 2: Cumulative survival curves of patients who underwent liver resection for hepatic metastasis according to the era of their treatment. A. The recurrence-free survival (RFS) rates in era 2 were significantly better than the RFS rates in era 1 (p = 0.013). B. The overall survival (OS) rate in era 2 was better than the OS rate in era 1 (p < 0.0001).

Mentions: Overall, the 3-, 5-, and 10-year RFS rates were 24.0%, 21.1%, and 19.5%, respectively, and the 3-, 5-, and 10-year OS rates were 41.3%, 32.1%, and 23.4%, respectively (Figure 1). Upon further analyses of the survival rates of patients who received LR for hepatic metastasis according to the era in which they occurred, we found that the outcome of patients in era 2 was significantly better than that of patients in era 1 (Figure 2). Era 2 patients had better RFS curves, and the 1-, 3-, and 5-year RFS rates were 55.6%, 28.2%, and 26.2%, respectively, with a median time of CRC recurrence of 16.5 months. The 1-, 3-, and 5-year RFS rates in era 1 patients were 35.1%, 19.1%, and 15.6%, respectively, with a median time of CRC recurrence of 10.0 months (Figure 2A; p = 0.013). The 1-, 3-, and 5-year OS rates of the patients in era 2 (89.3%, 56.5%, and 45.2%, respectively, with a median survival of 44.6 months) were better than those of patients in era 1 (77.2%, 25.2%, and 18.9%, respectively, with a median survival of 19 months) (Figure 2B; p < 0.0001).


Outcomes of resection for colorectal cancer hepatic metastases stratified by evolving eras of treatment.

Chan KM, Chiang JM, Lee CF, Yu MC, Lee WC, Chen JS, Wang JY - World J Surg Oncol (2011)

Cumulative survival curves of patients who underwent liver resection for hepatic metastasis according to the era of their treatment. A. The recurrence-free survival (RFS) rates in era 2 were significantly better than the RFS rates in era 1 (p = 0.013). B. The overall survival (OS) rate in era 2 was better than the OS rate in era 1 (p < 0.0001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3278383&req=5

Figure 2: Cumulative survival curves of patients who underwent liver resection for hepatic metastasis according to the era of their treatment. A. The recurrence-free survival (RFS) rates in era 2 were significantly better than the RFS rates in era 1 (p = 0.013). B. The overall survival (OS) rate in era 2 was better than the OS rate in era 1 (p < 0.0001).
Mentions: Overall, the 3-, 5-, and 10-year RFS rates were 24.0%, 21.1%, and 19.5%, respectively, and the 3-, 5-, and 10-year OS rates were 41.3%, 32.1%, and 23.4%, respectively (Figure 1). Upon further analyses of the survival rates of patients who received LR for hepatic metastasis according to the era in which they occurred, we found that the outcome of patients in era 2 was significantly better than that of patients in era 1 (Figure 2). Era 2 patients had better RFS curves, and the 1-, 3-, and 5-year RFS rates were 55.6%, 28.2%, and 26.2%, respectively, with a median time of CRC recurrence of 16.5 months. The 1-, 3-, and 5-year RFS rates in era 1 patients were 35.1%, 19.1%, and 15.6%, respectively, with a median time of CRC recurrence of 10.0 months (Figure 2A; p = 0.013). The 1-, 3-, and 5-year OS rates of the patients in era 2 (89.3%, 56.5%, and 45.2%, respectively, with a median survival of 44.6 months) were better than those of patients in era 1 (77.2%, 25.2%, and 18.9%, respectively, with a median survival of 19 months) (Figure 2B; p < 0.0001).

Bottom Line: Analysis of recurrence-free and overall survival rates also showed that the patient outcome was significantly better in the post-2003 era than in the pre-2003 era.Further analysis showed that a significantly higher percentage of patients in era 2 had received modern chemotherapeutic regimens including irinotecan and oxaliplatin, while patients in era 1 were mainly administered fluorouracil and leucovorin for adjuvant chemotherapy.However, the management and outcomes of patients with CRC hepatic metastasis have greatly improved with time, suggesting that the current use of aggressive multimodality treatments including surgical resection combined with modern chemotherapeutic regimens effectively prolongs the life expectancy of these patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan. chankunming@adm.cgmh.org.tw

ABSTRACT

Background and purpose: The outcomes and management of colorectal cancer (CRC) hepatic metastasis have undergone many evolutionary changes. In this study, we aimed to analyze the outcomes of patients with CRC hepatic metastasis in terms of the era of treatment.

Methods: We conducted a retrospective review of 279 patients who underwent liver resection (LR) for CRC hepatic metastases. The prognoses of patients treated pre-2003 (era 1) and post-2003 (era 2) were examined.

Results: Of the patients included in the study, 210 (75.3%) had CRC recurrence after LR. There was a significant difference in the ratio of CRC recurrence between the 2 eras (82.0% in era 1 vs. 69.5% in era 2; p = 0.008). Analysis of recurrence-free and overall survival rates also showed that the patient outcome was significantly better in the post-2003 era than in the pre-2003 era. Further analysis showed that a significantly higher percentage of patients in era 2 had received modern chemotherapeutic regimens including irinotecan and oxaliplatin, while patients in era 1 were mainly administered fluorouracil and leucovorin for adjuvant chemotherapy. Among patients with CRC recurrence, a significant ratio of those in era 2 underwent surgical resection for recurrent lesions, and these patients had a better survival curve than did patients without resection (34.1% vs. 2.2% for 5-year survival; p < 0.0001).

Conclusion: The incidence of CRC recurrence after LR for hepatic metastasis remains very high. However, the management and outcomes of patients with CRC hepatic metastasis have greatly improved with time, suggesting that the current use of aggressive multimodality treatments including surgical resection combined with modern chemotherapeutic regimens effectively prolongs the life expectancy of these patients.

Show MeSH
Related in: MedlinePlus