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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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Resection rates of colorectal liver metastases. A Resection rate of colorectal liver metastases (CLM) in % by year of CLM diagnosis. B Resection rate of CLM by year of CLM diagnosis in a subgroup of patients diagnosed with 1–3 CLM. C Resection rate of CLM by treatment centre: 2 academic liver centres compared with 28 regional hospitals.
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Fig3: Resection rates of colorectal liver metastases. A Resection rate of colorectal liver metastases (CLM) in % by year of CLM diagnosis. B Resection rate of CLM by year of CLM diagnosis in a subgroup of patients diagnosed with 1–3 CLM. C Resection rate of CLM by treatment centre: 2 academic liver centres compared with 28 regional hospitals.

Mentions: Of 1426 patients diagnosed with CLM, 383 (26.8%) patients were documented to have 3 or less hepatic metastases and 729 (51.1%) patients showed more than 3 metastases. The number of hepatic lesions was not documented in 314 patients (22%, see Additional file 3: Table S3). These proportions remained comparable throughout all cohorts (see Additional file 4: Table S4). The surgical approach chosen is shown in Additional file 3: Table S3, with the majority of patients undergoing atypical liver resections. In total, 374 of the 1426 CLM patients underwent hepatic resection in curative intent, representing an overall resection rate of 26.2%. Hepatic resection rates increased over time from 16.6% in 2002 to >21% in the years 2003–2005 (2003: 27.2%; 2004: 21.5%; 2005: 23.9%) to >30% after 2005 (2006: 32.4%; 2007 and later: 31.9%, see Figure 3A). A subgroup analysis, only taking into account CLM patients with three or less hepatic metastases, showed an overall average resection rate of 52.2%, increasing from 46.6% in 2002–2003 to >61% after 2005 (see Figure 3B). Hepatic resections were performed in a total of 30 hospitals; including 2 centres specialized in liver surgery. In 197 of 374 patients (=52.7%) undergoing liver resection, hepatic surgery was performed in one of these two centres and an overall resection rate of 46.6% was documented, compared to an overall resection rate of 22.0% in CLM patients treated in regional hospitals (see Figure 3C).Figure 3


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)

Resection rates of colorectal liver metastases. A Resection rate of colorectal liver metastases (CLM) in % by year of CLM diagnosis. B Resection rate of CLM by year of CLM diagnosis in a subgroup of patients diagnosed with 1–3 CLM. C Resection rate of CLM by treatment centre: 2 academic liver centres compared with 28 regional hospitals.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Resection rates of colorectal liver metastases. A Resection rate of colorectal liver metastases (CLM) in % by year of CLM diagnosis. B Resection rate of CLM by year of CLM diagnosis in a subgroup of patients diagnosed with 1–3 CLM. C Resection rate of CLM by treatment centre: 2 academic liver centres compared with 28 regional hospitals.
Mentions: Of 1426 patients diagnosed with CLM, 383 (26.8%) patients were documented to have 3 or less hepatic metastases and 729 (51.1%) patients showed more than 3 metastases. The number of hepatic lesions was not documented in 314 patients (22%, see Additional file 3: Table S3). These proportions remained comparable throughout all cohorts (see Additional file 4: Table S4). The surgical approach chosen is shown in Additional file 3: Table S3, with the majority of patients undergoing atypical liver resections. In total, 374 of the 1426 CLM patients underwent hepatic resection in curative intent, representing an overall resection rate of 26.2%. Hepatic resection rates increased over time from 16.6% in 2002 to >21% in the years 2003–2005 (2003: 27.2%; 2004: 21.5%; 2005: 23.9%) to >30% after 2005 (2006: 32.4%; 2007 and later: 31.9%, see Figure 3A). A subgroup analysis, only taking into account CLM patients with three or less hepatic metastases, showed an overall average resection rate of 52.2%, increasing from 46.6% in 2002–2003 to >61% after 2005 (see Figure 3B). Hepatic resections were performed in a total of 30 hospitals; including 2 centres specialized in liver surgery. In 197 of 374 patients (=52.7%) undergoing liver resection, hepatic surgery was performed in one of these two centres and an overall resection rate of 46.6% was documented, compared to an overall resection rate of 22.0% in CLM patients treated in regional hospitals (see Figure 3C).Figure 3

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