Patterns and Predictors of Recurrence After Curative Resection of Colorectal Liver Metastasis (CRLM)

Overview

Journal J Gastrointest Cancer

Publisher Springer

Specialties Gastroenterology
Oncology

Date 2024 Aug 22

PMID 39172317

Authors

Satya Niharika Vadisetti

Mufaddal Kazi

Shraddha Patkar

Rohit Mundhada

Ashwin DeSouza

Avanish Saklani

Mahesh Goel

Affiliations

Soon will be listed here.

Abstract

Background: Our study aims to determine the predictors and patterns of relapses after curative colorectal liver metastasis (CRLM) resection.

Methods: A single-centre, retrospective study of CRLM patients operated between 2010 and 2022 was performed. The site of first recurrence was either hepatic (marginal (≤ 1 cm) or extramarginal), extrahepatic, or both. Factors that predicted relapse patterns and overall survival were determined by multivariable Cox regression analysis with backward elimination of variables.

Results: The study consisted of 258 patients, with a similar proportion of synchronous (144; 56%) and metachronous(114; 43%) metastasis. At a 43-month median follow-up, 156 patients (60.4%) developed recurrences with 33 (21.1%) in the liver, 62(24.03%) extra-hepatic recurrences, and 58 (22.48%) having both. Isolated marginal liver relapses were seen in seven (9.89%) liver recurrence patients. The median overall and relapse-free survivals were 38 months (30-54) and 13 months (11-16), respectively. The 3-year liver-relapse-free survival was 54.4% (44.9-60.6). Size of liver metastases > 5 cm (HR 2.06 (1.34-3.17), involved surgical margins (HR 2.16 (1.27-3.68)), and adjuvant chemotherapy (HR 1.89 (1.07-3.35)) were predictors of hepatic recurrences. Node positivity of primary (HR 1.61 (1.02-2.56)), presence of baseline extra-hepatic metastases (HR 0.30 (0.18-0.51)), size of liver metastases > 5 cm (HR 2.02 (1.37-2.99)), poorly differentiated histology (HR 2.25 (1.28-3.49)), presence of LVI (HR 2.25 (1.28-3.94)), and adjuvant chemotherapy (HR 2.15 (1.28-3.61)) were predictors of extra-hepatic recurrences.

Conclusion: The study found majority relapses occurred at extrahepatic sites whilst isolated marginal recurrences were few. The consistent predictors of recurrence were size and inability to deliver adjuvant therapy. A tailored adjuvant therapy might improve outcomes after liver metastasectomy in colorectal cancers.

References

Matias M, Casa-Nova M, Faria M, Pires R, Tato-Costa J, Ribeiro L . Prognostic Factors after Liver Resection for Colorectal Liver Metastasis. Acta Med Port. 2015; 28(3):357-69. DOI: 10.20344/amp.4816. View

Creasy J, Sadot E, Groot Koerkamp B, Chou J, Gonen M, Kemeny N . Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?. Surgery. 2018; 163(6):1238-1244. PMC: 7439273. DOI: 10.1016/j.surg.2018.01.004. View

Jong M, Pulitano C, Ribero D, Strub J, Mentha G, Schulick R . Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009; 250(3):440-8. DOI: 10.1097/SLA.0b013e3181b4539b. View

John S, Robinson S, Rehman S, Harrison B, Vallance A, French J . Prognostic factors and survival after resection of colorectal liver metastasis in the era of preoperative chemotherapy: an 11-year single-centre study. Dig Surg. 2013; 30(4-6):293-301. DOI: 10.1159/000354310. View

Patel R, Rahman S, Schwantes I, Bartlett A, Eil R, Farsad K . Updated Management of Colorectal Cancer Liver Metastases: Scientific Advances Driving Modern Therapeutic Innovations. Cell Mol Gastroenterol Hepatol. 2023; 16(6):881-894. PMC: 10598050. DOI: 10.1016/j.jcmgh.2023.08.012. View

Dupre A, Malik H, Jones R, Diaz-Nieto R, Fenwick S, Poston G . Influence of the primary tumour location in patients undergoing surgery for colorectal liver metastases. Eur J Surg Oncol. 2017; 44(1):80-86. DOI: 10.1016/j.ejso.2017.10.218. View

Kobayashi K, Ono Y, Kitano Y, Oba A, Sato T, Ito H . Prognostic Impact of Tumor Markers (CEA and CA19-9) on Patients with Resectable Colorectal Liver Metastases Stratified by Tumor Number and Size: Potentially Valuable Biologic Markers for Preoperative Treatment. Ann Surg Oncol. 2023; 30(12):7338-7347. DOI: 10.1245/s10434-023-13781-0. View

. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310(20):2191-4. DOI: 10.1001/jama.2013.281053. View

DAngelica M, Kornprat P, Gonen M, DeMatteo R, Fong Y, Blumgart L . Effect on outcome of recurrence patterns after hepatectomy for colorectal metastases. Ann Surg Oncol. 2010; 18(4):1096-103. DOI: 10.1245/s10434-010-1409-1. View

10.

Sakamoto K, Beppu T, Ogawa K, Tamura K, Honjo M, Funamizu N . Prognostic Impact of Surgical Margin Width in Hepatectomy for Colorectal Liver Metastasis. J Clin Transl Hepatol. 2023; 11(3):705-717. PMC: 10037520. DOI: 10.14218/JCTH.2022.00383. View

11.

Sree Ganesh B, Kazi M, Goel M, Saklani A, De Souza A, Devarmani S . Feasibility of Hepatic Artery Infusion Chemotherapy for Colorectal Liver Metastasis in an Indian Setting. Indian J Surg Oncol. 2024; 15(Suppl 2):275-280. PMC: 11133240. DOI: 10.1007/s13193-023-01871-0. View

12.

Symeonidis D, Tepetes K, Tzovaras G, Kissa L, Samara A, Bompou E . Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted?. Clin Pract. 2022; 12(6):1102-1110. PMC: 9777184. DOI: 10.3390/clinpract12060112. View

13.

Wang H, Wang L, Jin K, Bao Q, Li J, Wang K . The prognostic impact of resection margin status varies according to the genetic and morphological evaluation (GAME) score for colorectal liver metastasis. J Surg Oncol. 2021; 124(4):619-626. DOI: 10.1002/jso.26557. View

14.

Kawaguchi Y, Kopetz S, Tran Cao H, Panettieri E, De Bellis M, Nishioka Y . Contour prognostic model for predicting survival after resection of colorectal liver metastases: development and multicentre validation study using largest diameter and number of metastases with RAS mutation status. Br J Surg. 2021; 108(8):968-975. PMC: 8378514. DOI: 10.1093/bjs/znab086. View

15.

Buisman F, Filipe W, Galjart B, Grunhagen D, Homs M, Moelker A . Adjuvant intra-arterial chemotherapy for patients with resected colorectal liver metastases: a systematic review and meta-analysis. HPB (Oxford). 2021; 24(3):299-308. DOI: 10.1016/j.hpb.2021.10.014. View

16.

Tomlinson J, Jarnagin W, DeMatteo R, Fong Y, Kornprat P, Gonen M . Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007; 25(29):4575-80. DOI: 10.1200/JCO.2007.11.0833. View

17.

Nordlinger B, Sorbye H, Glimelius B, Poston G, Schlag P, Rougier P . Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008; 371(9617):1007-16. PMC: 2277487. DOI: 10.1016/S0140-6736(08)60455-9. View

18.

Driedger M, Cleary S, Nagorney D . Synchronous colorectal liver metastases: therapeutic considerations. Hepatobiliary Surg Nutr. 2021; 10(5):711-713. PMC: 8527413. DOI: 10.21037/hbsn-21-239. View

19.

Kitsel Y, Cooke T, Sotirchos V, Sofocleous C . Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies. Cancers (Basel). 2023; 15(6). PMC: 10046329. DOI: 10.3390/cancers15061679. View

20.

Sonbol M, Siddiqi R, Uson P, Pathak S, Firwana B, Botrus G . The Role of Systemic Therapy in Resectable Colorectal Liver Metastases: Systematic Review and Network Meta-Analysis. Oncologist. 2022; 27(12):1034-1040. PMC: 9732220. DOI: 10.1093/oncolo/oyac212. View