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Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?

Publication ,  Journal Article
Creasy, JM; Sadot, E; Koerkamp, BG; Chou, JF; Gonen, M; Kemeny, NE; Balachandran, VP; Kingham, TP; DeMatteo, RP; Allen, PJ; Blumgart, LH ...
Published in: Surgery
June 2018

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.

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Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

June 2018

Volume

163

Issue

6

Start / End Page

1238 / 1244

Location

United States

Related Subject Headings

  • Young Adult
  • Survival Rate
  • Surgery
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans
  • Hepatectomy
  • Female
 

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Creasy, J. M., Sadot, E., Koerkamp, B. G., Chou, J. F., Gonen, M., Kemeny, N. E., … D’Angelica, M. I. (2018). Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure? Surgery, 163(6), 1238–1244. https://doi.org/10.1016/j.surg.2018.01.004
Creasy, John M., Eran Sadot, Bas Groot Koerkamp, Joanne F. Chou, Mithat Gonen, Nancy E. Kemeny, Vinod P. Balachandran, et al. “Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?Surgery 163, no. 6 (June 2018): 1238–44. https://doi.org/10.1016/j.surg.2018.01.004.
Creasy JM, Sadot E, Koerkamp BG, Chou JF, Gonen M, Kemeny NE, et al. Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure? Surgery. 2018 Jun;163(6):1238–44.
Creasy, John M., et al. “Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?Surgery, vol. 163, no. 6, June 2018, pp. 1238–44. Pubmed, doi:10.1016/j.surg.2018.01.004.
Creasy JM, Sadot E, Koerkamp BG, Chou JF, Gonen M, Kemeny NE, Balachandran VP, Kingham TP, DeMatteo RP, Allen PJ, Blumgart LH, Jarnagin WR, D’Angelica MI. Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure? Surgery. 2018 Jun;163(6):1238–1244.
Journal cover image

Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

June 2018

Volume

163

Issue

6

Start / End Page

1238 / 1244

Location

United States

Related Subject Headings

  • Young Adult
  • Survival Rate
  • Surgery
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Liver Neoplasms
  • Humans
  • Hepatectomy
  • Female