title: Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model.
abstract: OBJECTIVE
  To determine the utility of hepatic resection (HR) in the treatment of patients with noncolorectal nonendocrine liver metastases (NCNELM).
  
  
  BACKGROUND
  The place of HR in the treatment of NCNELM remains controversial, primarily due to the limitations of previously published reports and the heterogeneity of primary tumor sites and histologies.
  
  
  METHODS
  A multivariate risk model was developed by analyzing prognostic factors and long-term outcomes in 1452 patients with NCNELM treated with HR at 41 centers from 1983 to 2004.
  
  
  RESULTS
  Hepatic metastases were solitary in 56% and unilateral in 71% (mean diameter, 50.5 mm). Extrahepatic metastases were present in 22%. The most common primary sites were breast (32%), gastrointestinal (16%), and urologic (14%). The most common histologies were adenocarcinoma (60%), GIST/sarcoma (13.5%), and melanoma (13%). R0 resection was achieved in 83% of patients with a 60-day mortality rate of 2.3% and a major complication rate of 21.5%. Tumor recurred in 67% of patients (liver, 24%; extrahepatic, 18%; both, 25%). Overall and disease-free survivals at 5 years were 36% and 21% and at 10 years were 23% and 15%, respectively. In multivariate analysis, factors associated with poor prognosis were patient age >60 years, nonbreast origin, melanoma or squamous histology, disease-free interval <12 months, extrahepatic metastases, R2 resection, and major hepatectomy (all P < or = 0.02). A prognostic model based on these factors effectively stratified patients into low-risk (0-3 points, 46% 5-year survival), mid-risk (4-6 points, 33% 5-year survival), and high-risk (>6 points, <10% 5-year survival) groups (P = 0.0001).
  
  
  CONCLUSIONS
  HR for NCNELM is safe and effective, with outcomes mainly dependent on primary tumor site and histology. For individual patients, a statistical model based on key prognostic factors could validate the indication for hepatic resection by predicting long-term survivals.
authors.affiliation: Paul Brousse Hospital, Villejuif, France. rene.adam@pbr.aphp.fr
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Laurence
authors.initials: L
authors.lastname: Chiche
authors.forename: Thomas
authors.initials: T
authors.lastname: Aloia
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: Rémy
authors.initials: R
authors.lastname: Salmon
authors.forename: Michel
authors.initials: M
authors.lastname: Rivoire
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Jean
authors.initials: J
authors.lastname: Saric
authors.forename: Yves Patrice
authors.initials: YP
authors.lastname: Le Treut
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Georges
authors.initials: G
authors.lastname: Mantion
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D015996:Survival Rate