Limits...
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.

Show MeSH

Related in: MedlinePlus

Ten year overall survival analyses. A Comparison of 10-year OS in colorectal cancer cases with (n = 1426) an without (n = 4346) liver metastases (CLM) 2002–2007. B Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients by number of CLM independent of CLM resection. (1CLM: n = 236; 2-3CLM: n = 147; >3CLM: n = 729; unknown number of CLM: n = 314). C Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients with (n = 374) and without (n = 1052) curative liver resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Ten year overall survival analyses. A Comparison of 10-year OS in colorectal cancer cases with (n = 1426) an without (n = 4346) liver metastases (CLM) 2002–2007. B Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients by number of CLM independent of CLM resection. (1CLM: n = 236; 2-3CLM: n = 147; >3CLM: n = 729; unknown number of CLM: n = 314). C Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients with (n = 374) and without (n = 1052) curative liver resection.

Mentions: Kaplan Meier curves analysing the 10-year OS are shown in Figures 4 and 5, results for 1-, 2-, 5- and 10-year survival are shown in Table 2. CRC patients diagnosed with CLM showed a significantly lower 10-year OS compared to CRC patients without liver metastases (4.6% versus 29.8%, respectively, median survival 1.7 versus 6.3 years, p <0.001, Figure 4A and Table 2). Survival analyses in relation to the number of hepatic metastases are shown in Figure 4B and Table 2. Patients with three or less CLM had a significantly longer median survival than patients with more than three or unknown number of liver metastases (median survival 2.3 years versus 1.0 years, p =0.02). 10-year OS was 15.1% in patients with 1 CLM versus 2.6% in patients with more than three CLM, irrespective of hepatic resection. CLM patients who underwent hepatic resection showed a median survival of 4.3 years versus 1.9 years in CLM not undergoing liver resection (p <0.001), translating into a 5-year and 10-year OS of 32.2% and 17.6% versus 4.0% and 1.1%, respectively (see Figure 4C, Table 2). This significant benefit of hepatic resection was especially pronounced in patients with 3 or less metastases (5-year OS 40.6% versus 1.4%, p <0.001), but remained significant also for patients diagnosed with multiple or unknown number of hepatic metastases (see Figure 5, Table 2). Notably, only 52% of patients diagnosed with a single liver metastasis underwent hepatic resection (see Additional file 5: Table S5, Figure 3B). This finding is of particular importance, as patients with a single CLM who undergo hepatic resection show a similar long-time survival as CRC patients who do not develop any CLM (10-year OS in resected 1 CLM patients 28.3%, in CRC patients with no CLM 29.8%, n.s.; Table 2).Figure 4


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)

Ten year overall survival analyses. A Comparison of 10-year OS in colorectal cancer cases with (n = 1426) an without (n = 4346) liver metastases (CLM) 2002–2007. B Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients by number of CLM independent of CLM resection. (1CLM: n = 236; 2-3CLM: n = 147; >3CLM: n = 729; unknown number of CLM: n = 314). C Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients with (n = 374) and without (n = 1052) curative liver resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Ten year overall survival analyses. A Comparison of 10-year OS in colorectal cancer cases with (n = 1426) an without (n = 4346) liver metastases (CLM) 2002–2007. B Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients by number of CLM independent of CLM resection. (1CLM: n = 236; 2-3CLM: n = 147; >3CLM: n = 729; unknown number of CLM: n = 314). C Comparison of 10-year OS in colorectal cancer liver metastases (CLM) patients with (n = 374) and without (n = 1052) curative liver resection.
Mentions: Kaplan Meier curves analysing the 10-year OS are shown in Figures 4 and 5, results for 1-, 2-, 5- and 10-year survival are shown in Table 2. CRC patients diagnosed with CLM showed a significantly lower 10-year OS compared to CRC patients without liver metastases (4.6% versus 29.8%, respectively, median survival 1.7 versus 6.3 years, p <0.001, Figure 4A and Table 2). Survival analyses in relation to the number of hepatic metastases are shown in Figure 4B and Table 2. Patients with three or less CLM had a significantly longer median survival than patients with more than three or unknown number of liver metastases (median survival 2.3 years versus 1.0 years, p =0.02). 10-year OS was 15.1% in patients with 1 CLM versus 2.6% in patients with more than three CLM, irrespective of hepatic resection. CLM patients who underwent hepatic resection showed a median survival of 4.3 years versus 1.9 years in CLM not undergoing liver resection (p <0.001), translating into a 5-year and 10-year OS of 32.2% and 17.6% versus 4.0% and 1.1%, respectively (see Figure 4C, Table 2). This significant benefit of hepatic resection was especially pronounced in patients with 3 or less metastases (5-year OS 40.6% versus 1.4%, p <0.001), but remained significant also for patients diagnosed with multiple or unknown number of hepatic metastases (see Figure 5, Table 2). Notably, only 52% of patients diagnosed with a single liver metastasis underwent hepatic resection (see Additional file 5: Table S5, Figure 3B). This finding is of particular importance, as patients with a single CLM who undergo hepatic resection show a similar long-time survival as CRC patients who do not develop any CLM (10-year OS in resected 1 CLM patients 28.3%, in CRC patients with no CLM 29.8%, n.s.; Table 2).Figure 4

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