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
DOI/URL:
Notes: Article -- Export Date: 2 July 2018 -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    137 Chou
  2. Leslie H Blumgart
    300 Blumgart
  3. Ronald P Dematteo
    558 Dematteo
  4. Mithat Gonen
    652 Gonen
  5. Peter Allen
    398 Allen
  6. William R Jarnagin
    533 Jarnagin
  7. T Peter Kingham
    259 Kingham
  8. Nancy Kemeny
    293 Kemeny
  9. Eran Sadot
    33 Sadot
  10. John Creasy
    6 Creasy