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

Creasy, John M. ; Sadot, Eran ; Koerkamp, Bas Groot ; Chou, Joanne F. ; Gonen, Mithat ; Kemeny, Nancy E. ; Balachandran, Vinod P. ; Kingham, T. Peter ; DeMatteo, Ronald P. ; Allen, Peter J. ; Blumgart, Leslie H. ; Jarnagin, William R. ; D'Angelica, Michael I.

Surgery, 2018-06, Vol.163 (6), p.1238-1244 [Periódico revisado por pares]

United States: Elsevier Inc

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  • Título:
    Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?
  • Autor: Creasy, John M. ; Sadot, Eran ; Koerkamp, Bas Groot ; Chou, Joanne F. ; Gonen, Mithat ; Kemeny, Nancy E. ; Balachandran, Vinod P. ; Kingham, T. Peter ; DeMatteo, Ronald P. ; Allen, Peter J. ; Blumgart, Leslie H. ; Jarnagin, William R. ; D'Angelica, Michael I.
  • É parte de: Surgery, 2018-06, Vol.163 (6), p.1238-1244
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: 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. 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. 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%. 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.
  • Editor: United States: Elsevier Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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