Survival after Combined Hepatic Metastasectomy and Chemotherapy in Patients with Concurrent Hepatic and Extrahepatic Colorectal Metastases: a SEER Database Analysis

Abstract

PurposeColorectal cancer is the second leading cause of death among all cancers worldwide. Hepatic metastases exist in approximately 50% of colorectal cancer patients. The purpose of this study was to assess the effect of combined hepatic metastasectomy and chemotherapy on overall survival in patients with concurrent hepatic and extrahepatic disease.MethodsA total of 2533 patients from the US Surveillance, Epidemiology, and End Results (SEER) database with concurrent colorectal liver metastasis (CRLM) and extrahepatic disease (EHD) between January 1, 2010, and December 31, 2014, were retrieved. Survival analysis with Kaplan-Meier and Cox regression analyses was performed to assess the effect of combined hepatic metastasectomy and chemotherapy on 5-year survival.ResultsTwo hundred and fourteen (8.4%) patients underwent combined hepatic metastasectomy and chemotherapy. The median survival time among patients who underwent combined hepatic metastasectomy and chemotherapy was significantly higher than that of patients who underwent chemotherapy alone (24 vs. 21 months; p < 0.0001). Furthermore, older age at diagnosis (≥ 60 years), American Indian/Alaska Native race, primary sites at the rectosigoid colon, sigmoid colon, and descending colon, grade III, and the presence of bone metastases were all significantly associated with higher 5-year mortality. Patients who underwent combined hepatic metastasectomy and chemotherapy were significantly associated with 22.2% less 5-year mortality than patients who received chemotherapy alone.ConclusionCombined hepatic metastasectomy with chemotherapy in CRLM patients with EHD yields better survival than chemotherapy alone.