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Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma.

Hackl C, Neumann P, Gerken M, Loss M, Klinkhammer-Schalke M, Schlitt HJ - BMC Cancer (2014)

Bottom Line: However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM.Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM.However, we still see a striking potential for further improvements in interdisciplinary CLM management.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93053 Regensburg, Germany. Christina.Hackl@ukr.de.

ABSTRACT

Background: Purpose of this study was to analyse the surgical management and long-term clinical outcome of patients diagnosed with colorectal liver metastases (CLM) over a period of 10 years using data from a German tumour registry.

Methods: Retrospective analysis of 5772 patients diagnosed with colorectal adenocarcinoma between 2002 and 2007. Follow-up was continued until 2012.

Results: 1426 patients (24.7%) had CLM; 1019 patients (71%) had synchronous, 407 patients (29%) developed metachronous CLM. Hepatic resection was performed in 374 of the 1426 CLM patients (26%). A significant increase in liver resection rate from 16.6% for the 2002 cohort to 32% in later cohorts was observed. In centers specialized in liver surgery, CLM resection rates reached 46.6%. However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM. Univariate and multivariate analyses adjusted for age, sex, year of resection, time of CLM diagnosis and number of CLM revealed a significant survival benefit for CLM resection (HR =0.355; CI 0.305-0.414). Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM.

Conclusions: We here present the first long-term, population-based analysis of the surgical management of CLM in Germany. Significant increase in hepatic resection rates, translating to a significant benefit in OS, was seen over years. However, we still see a striking potential for further improvements in interdisciplinary CLM management.

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Related in: MedlinePlus

Synopsis of patients analysed in the present study. A total of 5772 patients diagnosed with colorectal cancer (CRC) in the years 2002–2007 were included. Of these, 1426 patients developed hepatic metastases and 374 underwent hepatic resection.
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Fig1: Synopsis of patients analysed in the present study. A total of 5772 patients diagnosed with colorectal cancer (CRC) in the years 2002–2007 were included. Of these, 1426 patients developed hepatic metastases and 374 underwent hepatic resection.

Mentions: A total of 5772 patients, diagnosed with colorectal cancer (CRC) between January 2002 and December 2007, were included into the present analysis (see Figure 1). One thousand four-hundred and twenty-six patients (=24.7%) developed hepatic metastases. Synchronous metastases were diagnosed in 1019 patients (71.4% of CLM patients and 17.65% of all patients), 407 patients (28.5% of CLM patients and 7.05% of all patients) developed metachronous metastases. These relations and the absolute numbers of patients diagnosed with CRC and CLM per year is shown in Figure 2A. While 799 and 856 CRC patients were documented in the years 2002 and 2003, more than 1000 patients each year were documented in 2004–2007. Rates of synchronous and metachronous metastases remained constant in the above mentioned range. Of all CLM, 85.3% were diagnosed within 12 months, 94.0% within 24 months and 97.5% within 36 months after diagnosis of the primary CRC (see Figure 2B). In all cases, CLM diagnosis was based on ultrasound plus computed tomography and/or magnetic resonance imaging.Figure 1


Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma.

Hackl C, Neumann P, Gerken M, Loss M, Klinkhammer-Schalke M, Schlitt HJ - BMC Cancer (2014)

Synopsis of patients analysed in the present study. A total of 5772 patients diagnosed with colorectal cancer (CRC) in the years 2002–2007 were included. Of these, 1426 patients developed hepatic metastases and 374 underwent hepatic resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230526&req=5

Fig1: Synopsis of patients analysed in the present study. A total of 5772 patients diagnosed with colorectal cancer (CRC) in the years 2002–2007 were included. Of these, 1426 patients developed hepatic metastases and 374 underwent hepatic resection.
Mentions: A total of 5772 patients, diagnosed with colorectal cancer (CRC) between January 2002 and December 2007, were included into the present analysis (see Figure 1). One thousand four-hundred and twenty-six patients (=24.7%) developed hepatic metastases. Synchronous metastases were diagnosed in 1019 patients (71.4% of CLM patients and 17.65% of all patients), 407 patients (28.5% of CLM patients and 7.05% of all patients) developed metachronous metastases. These relations and the absolute numbers of patients diagnosed with CRC and CLM per year is shown in Figure 2A. While 799 and 856 CRC patients were documented in the years 2002 and 2003, more than 1000 patients each year were documented in 2004–2007. Rates of synchronous and metachronous metastases remained constant in the above mentioned range. Of all CLM, 85.3% were diagnosed within 12 months, 94.0% within 24 months and 97.5% within 36 months after diagnosis of the primary CRC (see Figure 2B). In all cases, CLM diagnosis was based on ultrasound plus computed tomography and/or magnetic resonance imaging.Figure 1

Bottom Line: However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM.Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM.However, we still see a striking potential for further improvements in interdisciplinary CLM management.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93053 Regensburg, Germany. Christina.Hackl@ukr.de.

ABSTRACT

Background: Purpose of this study was to analyse the surgical management and long-term clinical outcome of patients diagnosed with colorectal liver metastases (CLM) over a period of 10 years using data from a German tumour registry.

Methods: Retrospective analysis of 5772 patients diagnosed with colorectal adenocarcinoma between 2002 and 2007. Follow-up was continued until 2012.

Results: 1426 patients (24.7%) had CLM; 1019 patients (71%) had synchronous, 407 patients (29%) developed metachronous CLM. Hepatic resection was performed in 374 of the 1426 CLM patients (26%). A significant increase in liver resection rate from 16.6% for the 2002 cohort to 32% in later cohorts was observed. In centers specialized in liver surgery, CLM resection rates reached 46.6%. However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM. Univariate and multivariate analyses adjusted for age, sex, year of resection, time of CLM diagnosis and number of CLM revealed a significant survival benefit for CLM resection (HR =0.355; CI 0.305-0.414). Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM.

Conclusions: We here present the first long-term, population-based analysis of the surgical management of CLM in Germany. Significant increase in hepatic resection rates, translating to a significant benefit in OS, was seen over years. However, we still see a striking potential for further improvements in interdisciplinary CLM management.

Show MeSH
Related in: MedlinePlus