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Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis.

Publication ,  Journal Article
Tan, MCB; Butte, JM; Gonen, M; Kemeny, N; Fong, Y; Allen, PJ; Kingham, TP; Dematteo, RP; Jarnagin, WR; D'Angelica, MI
Published in: HPB (Oxford)
October 2013

BACKGROUND: For patients undergoing liver resection for colorectal metastases, specific clinico-pathological variables have been shown to be prognostic at baseline. This study analyses how the prognostic capability of these variables changes in a conditional survival model. METHODS: Retrospective review of a prospectively maintained database of patients who underwent an R0 resection of colorectal liver metastases from 1994 to 2004 at a single institution. RESULTS: In total, 807 patients were identified, with an 87-month median follow-up for survivors. Five- and 10-year disease-specific survivals (DSS) were 68% and 55%, respectively. The probability of further survival increased as the survival time increased. For 3-year survivors (n = 504), DSS were no longer significantly different between patients with a low (0-2) or high (3-5) clinical risk score (CRS, P = 0.19). On multivariate analysis, independent predictors of DSS for 3-year survivors were recurrence within the first 3 years after a liver resection, a pre-operative carcinoembryonic antigen (CEA) >200 ng/ml and disease-free interval <12 months prior to the diagnosis of liver metastasis. However, for those patients who were recurrence free at 1 year, no clinico-pathological variables retained prognostic significance. DISCUSSION: After 3 years of DSS and 1 year of recurrence-free survival, baseline clinico-pathological variables have a limited ability to predict future survival. Early post-operative recurrence appears to be the most useful single clinical feature in estimating conditional DSS.

Duke Scholars

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

October 2013

Volume

15

Issue

10

Start / End Page

803 / 813

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Neoplasm Recurrence, Local
  • Multivariate Analysis
  • Middle Aged
 

Citation

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Tan, M. C. B., Butte, J. M., Gonen, M., Kemeny, N., Fong, Y., Allen, P. J., … D’Angelica, M. I. (2013). Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis. HPB (Oxford), 15(10), 803–813. https://doi.org/10.1111/hpb.12136
Tan, Marcus C. B., Jean M. Butte, Mithat Gonen, Nancy Kemeny, Yuman Fong, Peter J. Allen, T Peter Kingham, Ronald P. Dematteo, William R. Jarnagin, and Michael I. D’Angelica. “Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis.HPB (Oxford) 15, no. 10 (October 2013): 803–13. https://doi.org/10.1111/hpb.12136.
Tan MCB, Butte JM, Gonen M, Kemeny N, Fong Y, Allen PJ, et al. Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis. HPB (Oxford). 2013 Oct;15(10):803–13.
Tan, Marcus C. B., et al. “Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis.HPB (Oxford), vol. 15, no. 10, Oct. 2013, pp. 803–13. Pubmed, doi:10.1111/hpb.12136.
Tan MCB, Butte JM, Gonen M, Kemeny N, Fong Y, Allen PJ, Kingham TP, Dematteo RP, Jarnagin WR, D’Angelica MI. Prognostic significance of early recurrence: a conditional survival analysis in patients with resected colorectal liver metastasis. HPB (Oxford). 2013 Oct;15(10):803–813.
Journal cover image

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

October 2013

Volume

15

Issue

10

Start / End Page

803 / 813

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Neoplasm Recurrence, Local
  • Multivariate Analysis
  • Middle Aged