Survival after hepatic resection in metastatic colorectal cancer: a population-based study.
BACKGROUND
Hepatectomy is the standard of care for patients with colorectal cancer who have isolated hepatic metastases; however, the long-term survival benefits of hepatectomy in this population have not been characterized well outside of case series. For the current study, a population-based database was used to compare the survival of patients with liver metastases from colorectal cancer who did and did not undergo hepatectomy.


METHODS
Patients aged >or=65 years with incident colorectal cancer who were diagnosed from 1991 to 2001 were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Liver metastasis diagnoses, colorectal resections, and hepatectomies were identified from hospital, outpatient, and physician-supplier claims. Patients who did not undergo colorectal resection were excluded. Five-year survival from the time of cancer diagnosis was determined by the Kaplan-Meier method. Cox proportional hazards models were used to evaluate survival.


RESULTS
Among 13,599 patients who were identified with incident colorectal cancer and liver metastases, 7673 patients (56.4%) presented with stage IV disease, and the remaining patients presented with earlier stage disease and developed subsequent metastases. Only 833 patients (6.1%) in the cohort underwent hepatic resection, and their 30-day mortality rate was 4.3%. The 5-year survival was 32.8% among patients who underwent hepatic resection, compared with 10.5% among patients who did not undergo hepatic resection (P < .0001), and better survival was observed in the subset of patients who presented initially with disease in stages I through III. In a Cox model, which was controlled for age, sex, race, comorbidities, and stage at presentation, lack of hepatic resection was associated with a 2.78-fold increased risk of death.


CONCLUSIONS
Although hepatectomy rates among patients with colorectal cancer were low, hepatic resection was associated with improved survival.
Cummings
Linda C
LC
Division of Gastroenterology, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA. linda.cummings@case.edu
Payes
Jonathan D
JD
Cooper
Gregory S
GS
D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D012042:Registries; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome