Prediction of recurrence patterns from hepatic parenchymal disease after resection of colorectal liver metastases Journal Article


Authors: Narayan, R. R.; Harris, J. W.; Chou, J. F.; Gönen, M.; Bao, F.; Shia, J.; Allen, P. J.; Balachandran, V. P.; Drebin, J. A.; Jarnagin, W. R.; Kemeny, N. E.; Kingham, T. P.; D’Angelica, M. I.
Article Title: Prediction of recurrence patterns from hepatic parenchymal disease after resection of colorectal liver metastases
Abstract: Background: Obesity and metabolic syndrome are associated with inflammatory hepatic parenchymal disease (HPD) and increased risk for recurrence after resection of colorectal liver metastases (CRLM). The independent impact of HPD on recurrence patterns has not been well defined. Methods: The nonalcoholic fatty liver disease activity score (NAS) was used to quantify HPD including steatosis and fibrosis for all patients with completely resected CRLM between April 2003 and March 2007. Clinicopathologic factors, perioperative history, and outcomes were compared with the NAS. Fisher’s exact test was used to examine the association between severe HPD (NAS ≥ 3) with clinical and perioperative characteristics. Kaplan–Meier methods were used to estimate recurrence-free survival (RFS). The cumulative incidences of recurrence [any intrahepatic recurrence (IHR), extrahepatic recurrence only (EHR), and death without recurrence (DWR)] were estimated using competing risks methods. Results: Among the 357 patients included in this study, microsteatosis was noted in 124 (35%) patients, severe HPD in 31 (9%), steatohepatitis in 14 (4%), and sinusoidal injury in 36 (10%). After median follow-up of 127 months (range 4–175 months), 10-year RFS was 22% [95% confidence interval (CI) 17–27%]. Ten-year cumulative incidence for IHR, EHR, and DWR was 37%, 30%, and 12%, respectively. After controlling for confounders, NAS ≥ 3 was independently associated with higher risk of IHR [hazard ratio (HR) 1.76, 95% CI 1.07–2.90, p = 0.027] and lower risk of EHR (HR 0.18, 95% CI 0.04–0.75, p = 0.019) on multivariable analysis. Conclusions: Severe HPD was associated with increased IHR risk and decreased EHR risk. Future investigation into whether improving HPD from reversible etiologies can reduce the risk for IHR is warranted. © 2019, Society of Surgical Oncology.
Keywords: adult; human tissue; aged; major clinical study; cancer recurrence; chemotherapy; follow up; incidence; carcinoembryonic antigen; prediction; risk factor; body mass; disease severity; death; preoperative period; diabetes mellitus; disease free interval; liver surgery; perioperative period; liver parenchyma; liver injury; correlational study; fatty liver; recurrence free survival; preoperative chemotherapy; liver fibrosis; colorectal liver metastasis; very elderly; human; male; female; article; liver sinusoid; nonalcoholic fatty liver disease activity score
Journal Title: Annals of Surgical Oncology
Volume: 27
Issue: 1
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2020-01-01
Start Page: 188
End Page: 195
Language: English
DOI: 10.1245/s10434-019-07934-3
PUBMED: 31617122
PROVIDER: scopus
PMCID: PMC7061284
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    331 Chou
  2. Mithat Gonen
    1029 Gonen
  3. Jinru Shia
    720 Shia
  4. Peter Allen
    501 Allen
  5. William R Jarnagin
    903 Jarnagin
  6. T Peter Kingham
    609 Kingham
  7. Nancy Kemeny
    543 Kemeny
  8. Jeffrey Adam Drebin
    165 Drebin
  9. Raja R Narayan
    18 Narayan
  10. Jennifer Whittington Harris
    5 Harris