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Predictors of early recurrence after resection of colorectal liver metastases.

Bhogal RH, Hodson J, Bramhall SR, Isaac J, Marudanayagam R, Mirza DF, Muiesan P, Sutcliffe RP - World J Surg Oncol (2015)

Bottom Line: Dukes C stage and male sex were significantly associated with early liver-only recurrence (P < 0.05).Tumour size ≥3.6 cm and tumour number (>2) were significantly associated with early systemic recurrence (P < 0.001).High-risk patients may be candidates for preoperative MRI and/or computed tomography-positron emission tomography (CT-PET) scan and should receive intensive postoperative surveillance.

View Article: PubMed Central - PubMed

Affiliation: University Hospitals of Birmingham, Metchley Lane, Birmingham, West Midlands, B15 2TT, UK. balsin@hotmail.com.

ABSTRACT

Background: Early recurrence after resection of colorectal liver metastases (CLM) is common. Patients at risk of early recurrence may be candidates for enhanced preoperative staging and/or earlier postoperative imaging. The aim of this study was to determine if there are any risk factors that specifically predict early liver-only and systemic recurrence.

Methods: Retrospective analysis of prospective database of patients undergoing liver resection (LR) for CLM from 2004 to 2006 was undertaken. Early recurrence was defined as occurring within 18 months of LR. Patients were classified into three groups: early liver-only recurrence, early systemic recurrence and recurrence-free. Preoperative factors were compared between patients with and without early recurrence.

Results: Two hundred and forty-three consecutive patients underwent LR for CLM. Twenty-seven patients (11%) developed early liver-only recurrence. Dukes C stage and male sex were significantly associated with early liver-only recurrence (P < 0.05). Sixty-six patients (27%) developed early systemic recurrence. Tumour size ≥3.6 cm and tumour number (>2) were significantly associated with early systemic recurrence (P < 0.001).

Conclusions: It is possible to stratify patients according to the risk of early liver-only or systemic recurrence after resection of CLM. High-risk patients may be candidates for preoperative MRI and/or computed tomography-positron emission tomography (CT-PET) scan and should receive intensive postoperative surveillance.

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Overall patient survival in following LR for CLM.
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Fig2: Overall patient survival in following LR for CLM.

Mentions: At a median follow-up of 58 months (range 33 to 74 months), 93 patients (38%) developed early recurrence (defined as within 18 months of surgery), including 27 patients (11%) with liver-only recurrence and 66 patients (27%) with systemic recurrence (with or without liver recurrence). Thirty-five patients (14%) developed late recurrence and 115 patients (47%) were recurrence-free at follow-up (Table 2). Median times to diagnosis of recurrence in patients with liver-only recurrence and systemic recurrence were similar: 11 [6-14] vs. 9.5 [6-14] months (P = 0.841). In patients with early liver-only recurrence, 19 patients (70%) had treatable lesions (repeat LR 11, radiofrequency ablation 8), and 8 patients were suitable for palliative treatment only. Seventeen patients (26%) with early systemic recurrence were amenable to further surgery (pulmonary metastasectomy, N = 13) or ablation (N = 4). Twenty-seven patients (41%) received palliative chemotherapy and the remaining 22 (33%) were suitable for best supportive care only. Five-year overall and disease-free survival rates in the entire cohort were 47% and 42%, respectively. Median survival in patients with disease recurrence (liver or systemic) was 6.5 months (range 2 to 26 months). As expected, disease recurrence was associated with significantly worse overall survival (Figure 2).Table 2


Predictors of early recurrence after resection of colorectal liver metastases.

Bhogal RH, Hodson J, Bramhall SR, Isaac J, Marudanayagam R, Mirza DF, Muiesan P, Sutcliffe RP - World J Surg Oncol (2015)

Overall patient survival in following LR for CLM.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389659&req=5

Fig2: Overall patient survival in following LR for CLM.
Mentions: At a median follow-up of 58 months (range 33 to 74 months), 93 patients (38%) developed early recurrence (defined as within 18 months of surgery), including 27 patients (11%) with liver-only recurrence and 66 patients (27%) with systemic recurrence (with or without liver recurrence). Thirty-five patients (14%) developed late recurrence and 115 patients (47%) were recurrence-free at follow-up (Table 2). Median times to diagnosis of recurrence in patients with liver-only recurrence and systemic recurrence were similar: 11 [6-14] vs. 9.5 [6-14] months (P = 0.841). In patients with early liver-only recurrence, 19 patients (70%) had treatable lesions (repeat LR 11, radiofrequency ablation 8), and 8 patients were suitable for palliative treatment only. Seventeen patients (26%) with early systemic recurrence were amenable to further surgery (pulmonary metastasectomy, N = 13) or ablation (N = 4). Twenty-seven patients (41%) received palliative chemotherapy and the remaining 22 (33%) were suitable for best supportive care only. Five-year overall and disease-free survival rates in the entire cohort were 47% and 42%, respectively. Median survival in patients with disease recurrence (liver or systemic) was 6.5 months (range 2 to 26 months). As expected, disease recurrence was associated with significantly worse overall survival (Figure 2).Table 2

Bottom Line: Dukes C stage and male sex were significantly associated with early liver-only recurrence (P < 0.05).Tumour size ≥3.6 cm and tumour number (>2) were significantly associated with early systemic recurrence (P < 0.001).High-risk patients may be candidates for preoperative MRI and/or computed tomography-positron emission tomography (CT-PET) scan and should receive intensive postoperative surveillance.

View Article: PubMed Central - PubMed

Affiliation: University Hospitals of Birmingham, Metchley Lane, Birmingham, West Midlands, B15 2TT, UK. balsin@hotmail.com.

ABSTRACT

Background: Early recurrence after resection of colorectal liver metastases (CLM) is common. Patients at risk of early recurrence may be candidates for enhanced preoperative staging and/or earlier postoperative imaging. The aim of this study was to determine if there are any risk factors that specifically predict early liver-only and systemic recurrence.

Methods: Retrospective analysis of prospective database of patients undergoing liver resection (LR) for CLM from 2004 to 2006 was undertaken. Early recurrence was defined as occurring within 18 months of LR. Patients were classified into three groups: early liver-only recurrence, early systemic recurrence and recurrence-free. Preoperative factors were compared between patients with and without early recurrence.

Results: Two hundred and forty-three consecutive patients underwent LR for CLM. Twenty-seven patients (11%) developed early liver-only recurrence. Dukes C stage and male sex were significantly associated with early liver-only recurrence (P < 0.05). Sixty-six patients (27%) developed early systemic recurrence. Tumour size ≥3.6 cm and tumour number (>2) were significantly associated with early systemic recurrence (P < 0.001).

Conclusions: It is possible to stratify patients according to the risk of early liver-only or systemic recurrence after resection of CLM. High-risk patients may be candidates for preoperative MRI and/or computed tomography-positron emission tomography (CT-PET) scan and should receive intensive postoperative surveillance.

Show MeSH
Related in: MedlinePlus