Liver resection offers hope for prolonged survival in patients with at least 10 CLM
Liver resection after effective chemotherapy may afford prolonged long-term survival in patients with ≥10 colorectal liver metastases (CLM) staged with preoperative magnetic resonance imaging (MRI), a study has found.
Researchers evaluated the outcome after liver surgery and identified prognostic factors of survival in a cohort of 12,406 patients who had underwent operation for CLM. Data were prospectively collected in the LiverMetSuvey registry.
Overall, the group of patients with ≥10 CLM (n=529) had a 5-year overall survival (OS) of 30 percent. A macroscopically complete (R0/R1) resection was achieved in 72.8 percent of patients, yielding 3- and 5-year OS rates of 61 and 39 percent, respectively, vs 29 and 5 percent for patients with R2 or no resection (p<0.0001).
In a multivariate Cox proportional hazards model, R0/R1 resection emerged as the strongest favourable factor of OS (hazard ratio [HR], 0.35; 95 percent CI, 0.26 to 0.48). Other independent favourable factors were maximal tumour size <40 mm (HR, 0.67; 0.49 to 0.92), age <60 years (HR, 0.66; 0.50 to 0.88), preoperative MRI (HR, 0.65; 0.47 to 0.89) and adjuvant chemotherapy (HR, 0.73; 0.55 to 0.98).
The model also showed that 5-year OS rates of 30 percent might be achieved provided that R0/R1 resection was associated with at least one additional favourable factor.
The long-term outcome of patients with ≥10 CLM is worse compared with those who exhibit fewer lesions, with surgery performed following effective chemotherapy remaining the only hope of prolonged survival, particularly in patients for whom complete resection can be performed, researchers said.
Based on the current data, “the number of CLM should not be considered as contraindication to surgery per se and should encourage oncologists and surgeons to extend the surgical indications beyond commonly admitted boundaries,” they added.