title: Pre-hepatectomy prognostic staging to determine treatment strategy for colorectal cancer metastases to the liver.
abstract: BACKGROUND
  Attempts at identifying prognostic factors after hepatectomy in patients with colorectal liver metastases have not achieved consensus. We investigated prognostic factors ascertainable before hepatectomy for colorectal metastasis.
  
  
  METHODS
  Clinicopathological data for 149 consecutive patients with colorectal cancer who underwent curative resection of primary lesions and metastatic liver disease at one institution were subjected to multivariate analysis concerning metastatic status and the primary lesion.
  
  
  RESULTS
  Poorly differentiated adenocarcinoma or mucinous carcinoma as the primary tumor (Poor/muc; P=0.026), marked vascular invasion by the primary tumor (V; P=0.002), bi-lobar liver metastases ( P=0.048), and short doubling time (DT) of the liver tumor ( P=0.028) were characteristics assessable before hepatectomy that independently indicated poorer survival. A four-stage classification based on these factors was related to overall ( P<0.01) and disease-free ( P<0.01) survival rates. No pattern of recurrence site was evident in stage I (patients with no risk factor). Recurrence was usually extrahepatic in stage IV (patients with Poor/muc) but favored the remnant liver in stage II (patients with bi-lobar metastases or short DT) or III (patients with V; P=0.037). Stage III showed more multiple and early hepatic recurrences than stage II, and repeat hepatectomy was less frequent ( P<0.05).
  
  
  CONCLUSIONS
  Pre-hepatectomy prognostic staging should help to guide treatment of liver metastases.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan. ktrj112@urahp.yokohama-cu.ac.jp
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Yoshirou
authors.initials: Y
authors.lastname: Fujii
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekido
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ike
mesh_terms: D015179:Colorectal Neoplasms; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D036542:Tomography, Spiral Computed; D014057:Tomography, X-Ray Computed