Actual 10-year survival after hepatic resection of colorectal liver metastases: What factors preclude cure? Journal Article
| Authors: | Creasy, J. M.; Sadot, E.; Koerkamp, B. G.; Chou, J. F.; Gonen, M.; Kemeny, N. E.; Balachandran, V. P.; Kingham, T. P.; DeMatteo, R. P.; Allen, P. J.; Blumgart, L. H.; Jarnagin, W. R.; D'Angelica, M. I. |
| Article Title: | Actual 10-year survival after hepatic resection of colorectal liver metastases: What factors preclude cure? |
| Abstract: | Background: Hepatic resection of colorectal liver metastases is associated with long-term survival. This study analyzes actual 10-year survivors after resection of colorectal liver metastases, reports the observed rate of cure, and identifies factors that preclude cure. Methods: A single-institution, prospectively maintained database was queried for all initial resections for colorectal liver metastases for the years 1992–2004. Observed cure was defined as actual 10-year survival with either no recurrence or resected recurrence with at least 3 years of disease-free follow-up. Clinical risk score was dichotomized into low (0–2) and high (3–5). Semiparametric proportional hazards mixture cure model was utilized to estimate probability of cure. Results: We included 1,211 patients with a median follow-up for survivors of 11 years. Median disease-specific survival was 4.9 years (95% CI: 4.4–5.3). 295 patients (24.4%) were actual 10-year survivors. The observed cure rate was 20.6% (n = 250). Among 250 cured patients, 192 (76.8%) had no recurrence and 58 (23.2%) had a resected recurrence with at least 3 years of disease-free follow-up. Extrahepatic disease (n = 88), carcinoembryonic antigen >200 ng/mL (n = 119), positive margin (n = 109), and >10 tumors (n = 31) had observed cure rates less than 10%. In cure model analysis, patients with both extrahepatic disease and high clinical risk score (n = 31) had an estimated probability of cure of 3.5%. Conclusion: Actual 10-year survival after resection of colorectal liver metastases is 24% with an observed 20% cure rate. Patients with both high clinical risk score and extrahepatic disease have an estimated probability of cure less than 5%. When such factors are identified, strong consideration may be given to preoperative strategies, such as neoadjuvant chemotherapy, to help select patients for surgical therapy. © 2018 Elsevier Inc. |
| Keywords: | adult; cancer survival; aged; major clinical study; cancer recurrence; follow up; carcinoembryonic antigen; cohort analysis; cancer survivor; survival time; scoring system; liver resection; disease specific survival; clinical risk score; colorectal liver metastasis; human; male; female; priority journal; article |
| Journal Title: | Surgery |
| Volume: | 163 |
| Issue: | 6 |
| ISSN: | 0039-6060 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2018-06-01 |
| Start Page: | 1238 |
| End Page: | 1244 |
| Language: | English |
| DOI: | 10.1016/j.surg.2018.01.004 |
| PROVIDER: | scopus |
| PUBMED: | 29455841 |
| PMCID: | PMC7439273 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 July 2018 -- Source: Scopus |
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