Predictors of extrahepatic recurrence after resection of colorectal liver metastases.
BACKGROUND
It is important to identify patients at high risk of extrahepatic recurrence after surgery for liver metastases, in order to maximize the survival benefit obtained by prophylactic regional chemotherapy.


METHODS
Data from 68 patients who underwent resection of colorectal liver metastases but who did not receive hepatic arterial chemotherapy or intravenous systemic chemotherapy were collected. Twenty-two variables were examined by univariate and multivariate analyses to determine which factors were relevant to extrahepatic recurrence. A scoring system was developed that included the most relevant factors.


RESULTS
The extrahepatic recurrence rate at 3 years after hepatectomy was 57.8 per cent. Three variables were independently associated with extrahepatic recurrence including raised serum level of carcinoembryonic antigen after hepatectomy (relative risk (RR) 5.4, P < 0.001), venous invasion of the primary tumour (RR 4.0, P = 0.001) and high-grade budding of the primary tumour (RR 3.1, P = 0.006). Patients with none of these risk factors had a 3-year extrahepatic recurrence rate of 7.1 per cent, compared with 61.6 per cent for those with one risk factor and 100 per cent for those with two or three risk factors.


CONCLUSIONS
It was possible to identify patients at high risk of disease relapse at extrahepatic sites. This system might be used on an individual basis to select patients with colorectal liver metastases for regional chemotherapy or systemic chemotherapy after surgical intervention.
Department of Surgery I, National Defence Medical College, Saitama, Japan. ueno@me.ndmc.ac.jp
H
H
Ueno
H
H
Mochizuki
Y
Y
Hashiguchi
K
K
Hatsuse
H
H
Fujimoto
K
K
Hase
D015179:Colorectal Neoplasms; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D012307:Risk Factors