Colorectal cancer liver metastases – a population-based study on incidence, management and survival

Zhang

British Journal of Surgery

et al. 2019

Background Primary tumour location is emerging as an important prognostic factor in localized and metastatic colorectal cancers. However, its prognostic role in colorectal liver metastasis (CRLM) after hepatectomy remains controversial. A systematic review and meta‐analysis was undertaken to evaluate its prognostic value. Methods References were identified through searches of PubMed, Embase, Web of Science and the Cochrane Library comparing overall or disease‐free survival after hepatic resection between patients with CRLM originating from right‐ or left‐sided colorectal cancers. Data were pooled using hazard ratios (HRs) and 95 per cent confidence intervals according to a random‐effects model. Meta‐regression and subgroup analyses were conducted to assess the effect of underlying confounding factors on HR estimates and to adjust for this. Results The final analysis included 21 953 patients from 45 study cohorts. Compared with left‐sided primary tumour location, right‐sided location was associated with worse overall survival (HR 1·39, 95 per cent c.i. 1·28 to 1·51; P < 0·001; prediction interval 1·00 to 1·93), and also tended to have a negative impact on disease‐free survival (HR 1·18, 1·06 to 1·32; P = 0·004; prediction interval 0·79 to 1·75). Subgroup analysis showed that the negative effect of right‐sided primary tumour location on overall survival was more prominent in the non‐Asian population (HR 1·47, 1·33 to 1·62) than the Asian population (HR 1·18, 1·05 to 1·32) (P for interaction <0·01). Conclusion This study demonstrated a prognostic role for primary tumour location in patients with CRLM receiving hepatectomy, especially regarding overall survival. Adding primary tumour location may provide important optimization of prognosis prediction models for CRLM in current use.

Section: Fig 2 Forest Plots Showing Impact Of Primary Tumour Locatiomentioning

confidence: 99%

Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases

Zhang

British Journal of Surgery

et al. 2019

“…A 5-year survival rate of 50-69 per cent is expected in many high-income countries 2 , and improvements in prognosis have been attributed to earlier detection, surgical technique and resection rate of primary, increasing use of systemic treatments and improvements in the treatment of stage IV disease, especially in older individuals 3 -5 . A decline in the mortality rate of patients with stage IV disease, with an absolute 5-year survival rate above 10 per cent during the past decade, has been associated with increased use of attempted curative treatment in some western European countries 5 -8 . Liver metastases develop in 20-30 per cent of all patients with colorectal cancer 9,10 . The indication for liver surgery has widened regarding number and size of metastases 11 , but is limited by the need for an adequate remnant liver volume and extrahepatic disease.…”

Section: Introductionmentioning

confidence: 99%

Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer

et al. 2020

Background: Resection of the primary tumour is a prerequisite for cure in patients with colorectal cancer, but hepatic metastasectomy has been used increasingly with curative intent. This national registry study examined prognostic factors for radically treated primary tumours, including the subgroup of patients undergoing liver metastasectomy. Methods: Patients who had radical resection of primary colorectal cancer in 2009-2013 were identified in a population-based Swedish colorectal registry and cross-checked in a registry of liver tumours. Data on primary tumour and patient characteristics were extracted and prognostic impact was analysed.Results: Radical resection was registered in 20 853 patients; in 38⋅7 per cent of those registered with liver metastases, surgery or ablation was performed. The age-standardized relative 5-year survival rate after radical resection of colorectal cancer was 80⋅9 (95 per cent c.i. 80⋅2 to 81⋅6) per cent, and the rate after surgery for colorectal liver metastases was 49⋅6 (46⋅0 to 53⋅2) per cent. Multivariable analysis identified lymph node status, multiple sites of metastasis, high ASA grade and postoperative complications after resection of the primary tumour as strong risk factors after primary resection and following subsequent liver resection or ablation. Age, sex and primary tumour location had no prognostic impact on mortality after liver resection.Conclusion: Lymph node status and complications have a negative impact on outcome after both primary resection and liver surgery. Older age and female sex were underrepresented in the liver surgical cohort, but these factors did not influence prognosis significantly.

J of Gastro and Hepatol

“…Approximately 25% of patients with CRC will develop liver metastases, of which only one quarter will be eligible for potentially curative surgery . Once patients develop colorectal liver metastasis (CRLM), their prognosis significantly deteriorates and hepatic resection offers the only chance of cure.…”

Section: Introductionmentioning

confidence: 99%

Searching for the link; mechanisms underlying liver regeneration and recurrence of colorectal liver metastasis post partial hepatectomy

Riddiough

Fifis

Muralidharan

et al. 2019

Despite excellent treatment of primary colorectal cancer, the majority of deaths occur as a result of metastasis to the liver. Recent population studies have estimated that one quarter of patients with colorectal cancer will incur synchronous or metachronous colorectal liver metastasis. However, only one quarter of these patients will be eligible for potentially curative resection. Tumor recurrence occurs in reportedly 60% of patients undergoing hepatic resection, and the majority of intrahepatic recurrence occurs within the first 6 months of surgery. The livers innate ability to restore its homeostatic size, and volume facilitates major hepatic resection that currently offers the only chance of cure to patients with extensive hepatic metastases. Experimental and clinical evidence supports the notion that following partial hepatectomy, liver regeneration (LR) paradoxically drives tumor progression and increases the risk of recurrence. It is becoming increasingly clear that the processes that drive liver organogenesis, regeneration, and tumor progression are inextricably linked. This presents a major hurdle in the management of colorectal liver metastasis and other hepatic malignancies because therapies that reduce the risk of recurrence without hampering LR are sought. The processes and pathways underlying these phenomena are multiple, complex, and cross‐communicate. In this review, we will summarize the common mechanisms contributing to both LR and tumor recurrence.