The prognostic implications of primary colorectal tumor location on recurrence and overall survival in patients undergoing resection for colorectal liver metastasis

Sasaki, Kazunari; Andreatos, Nikolaos; Margonis, Georgios Antonios; He, Jin; Weiss, Matthew J.; Johnston, Fabian M.; Wolfgang, Christopher L.; Antoniou, Efstathios; Pikoulis, Emmanouil; Pawlik, Timothy M.

doi:10.1002/jso.24425

Cited by 75 publications

(68 citation statements)

References 40 publications

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“…Similar with earlier analyses, demographic variables such age and gender were not associated with OS in the present study. Unlike recent reports which revealed that right sided colon tumors were associated with poorer OS after resection of CLMs (26,27), in the present analysis, the location of the primary did not significantly influence survival. Metastatic right sided tumors portend a more aggressive biology (than left-sided tumors), reflected mainly in more frequent hepatic and extrahepatic metastases and unresectable CLMs, but the influence of the primary tumor sidedness in patients with resectable CLMs was not proved in our series.…”

Section: Discussion Discussioncontrasting

confidence: 99%

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

Alexandrescu¹,

Diaconescu²,

Zarnescu³

et al. 2017

SGO

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Backgound: Several clinical risk factors for patients undergoing liver resection for colorectal liver metastases were suggested. The purpose of the study was to evaluate the prognostic factors for survival after resection of liver metastases from colorectal cancer in a high volume center for both hepatobiliary and colorectal surgery. Methods: We completed a retrospective analysis on 655 consecutive patients with liver resection for colorectal cancer metastasis operated in our centre between April 1996 and March 2016. Preoperative, intraoperative, pathologic, and outcome data for patients undergoing liver resection for metastatic colorectal were examined. Univariate analysis followed by multivariate Cox regression analysis was performed in order to identify the risk factors associated with prognostic factors related to survival. Results: There were 371 men (56.65%) and 284 women (43.35%), with a median age of 60 year-old (range 24 to 84). The primary tumor location was colon in 454 cases (69.31%) and rectum for 201 cases (30.69%). Synchronous tumors were resected in 353 cases (53.72%). The surgical mortality rate was 2.95%. The 5-year survival rate was 29.2%, and the 10-year survival rate was 17.1%. Four factors were found to be significant independent predictors of poor long-term outcome by multivariate analysis: bilobar liver metastasis (p = 0.003) with HR 1.653 (95%CI 1.180 -2.316), non-R0 resection (p < 0.001) with HR 6.066 (95%CI 3.508 -10.489), N2 lymph node stage (p = 0.007) with HR 1.528 (95%CI 1.125 -2.075) and lack of adjuvant chemotherapy (p = 0.046) with HR 1.703 (95%CI 1.009 -2.873). Conclusion:The independent prognostic factors for poor OS were both clinico-pathologic and therapeutic. In patients with good prognostic factors, an appropriate onco-surgical treatment is able to significantly prolong survival. In patients with poor prognostic factors, prognosis is mainly influenced by tumor biology and the benefit from current therapies is still modest.

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Section: Discussion Discussioncontrasting

confidence: 99%

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

Alexandrescu¹,

Diaconescu²,

Zarnescu³

et al. 2017

SGO

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“…Lymphovascular and perineural invasion have also been attributed as independent factors for survival 28,29 . Patients with right-sided tumours have longer recurrence-free survival than those with left-sided tumours, but at recurrence the course of the disease seems to be more complicated with shorter OS 30 . Patients with right-sided tumours have longer recurrence-free survival than those with left-sided tumours, but at recurrence the course of the disease seems to be more complicated with shorter OS 30 .…”

Section: Introductionmentioning

confidence: 98%

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

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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.

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“…Several single centres have recently investigated the prognostic role of primary tumour location (PTL) in patients with CRLM receiving surgical resection. Some studies showed that right‐sided PTL was an independent predictor of poorer overall survival (OS) and disease‐free survival (DFS) after hepatectomy compared with left‐sided PTL, but others found no prognostic difference. Whether PTL could act as an effective prognostic parameter in patients with surgically treated CRLM is still controversial and needs further investigation.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Zhang

Wang

et al. 2019

British Journal of Surgery

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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.

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The prognostic implications of primary colorectal tumor location on recurrence and overall survival in patients undergoing resection for colorectal liver metastasis

Cited by 75 publications

References 40 publications

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

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

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

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