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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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Kaplan-Meier cumulative survival curves of patients who underwent liver resection for hepatic metastasis after colorectal cancer recurrence. A. The survival curve of patients with intrahepatic recurrence (IHR) was relatively better than that of patients with systemic recurrence (SR) (p = 0.002). B. Patients who had undergone surgical resection of recurrent lesions had a better survival curve than did patients without resection (p < 0.0001).
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Figure 3: Kaplan-Meier cumulative survival curves of patients who underwent liver resection for hepatic metastasis after colorectal cancer recurrence. A. The survival curve of patients with intrahepatic recurrence (IHR) was relatively better than that of patients with systemic recurrence (SR) (p = 0.002). B. Patients who had undergone surgical resection of recurrent lesions had a better survival curve than did patients without resection (p < 0.0001).

Mentions: The cumulative survival rates from the time of identification of CRC recurrence after LR were further analyzed, and patients with IHR and SR had poor survival curves. Nonetheless, patients with IHR had a relatively better survival curve than patients with SR. The 3-year survival rates were 14.5% in patients with IHR and 8.9% in patients with SR (Figure 3A; p = 0.002). Of the 210 patients who developed CRC recurrence after LR, 41 (19.5%), including 24 with IHR and 17 with SR, underwent surgical resection for the recurrent tumor. Of these patients, 31 (29.5%) had CRC recurrence in era 2 and 10 (9.5%) had CRC recurrence in era 1. The comparison showed that the ratio of patients who underwent surgical resection for CRC recurrence was significantly higher in era 2 than in era 1 (Table 1; p = 0.003).


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)

Kaplan-Meier cumulative survival curves of patients who underwent liver resection for hepatic metastasis after colorectal cancer recurrence. A. The survival curve of patients with intrahepatic recurrence (IHR) was relatively better than that of patients with systemic recurrence (SR) (p = 0.002). B. Patients who had undergone surgical resection of recurrent lesions had a better survival curve than did patients without resection (p < 0.0001).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Kaplan-Meier cumulative survival curves of patients who underwent liver resection for hepatic metastasis after colorectal cancer recurrence. A. The survival curve of patients with intrahepatic recurrence (IHR) was relatively better than that of patients with systemic recurrence (SR) (p = 0.002). B. Patients who had undergone surgical resection of recurrent lesions had a better survival curve than did patients without resection (p < 0.0001).
Mentions: The cumulative survival rates from the time of identification of CRC recurrence after LR were further analyzed, and patients with IHR and SR had poor survival curves. Nonetheless, patients with IHR had a relatively better survival curve than patients with SR. The 3-year survival rates were 14.5% in patients with IHR and 8.9% in patients with SR (Figure 3A; p = 0.002). Of the 210 patients who developed CRC recurrence after LR, 41 (19.5%), including 24 with IHR and 17 with SR, underwent surgical resection for the recurrent tumor. Of these patients, 31 (29.5%) had CRC recurrence in era 2 and 10 (9.5%) had CRC recurrence in era 1. The comparison showed that the ratio of patients who underwent surgical resection for CRC recurrence was significantly higher in era 2 than in era 1 (Table 1; p = 0.003).

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