title: Liver-directed surgery for metastatic squamous cell carcinoma to the liver: results of a multi-center analysis.
abstract: BACKGROUND
  The role of hepatic resection for metastatic squamous cell carcinoma (SCC) remains unknown. The current study evaluates the role of hepatic resection in patients with metastatic SCC to the liver.
  
  
  METHODS
  Between 1988 and 2006, 52 patients underwent hepatic resection of metastatic SCC at eight major cancer centers. Clinicopathologic factors were analyzed with regard to disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  Primary SCC site was anal (n = 27), head/neck (n = 12), lung (n = 4), esophagus (n = 2), and other (n = 7). Treatment of primary SCC was chemotherapy +/- radiotherapy alone (n = 29), chemotherapy +/- radiotherapy + surgery (n = 15), or surgery alone (n = 8). Forty-seven patients underwent resection alone, 2 resection + radiofrequency ablation (RFA), and 3 RFA only. At last follow-up, 33 (63.5%) patients had recurred. The median time to recurrence was 9.8 months, and 5-year DFS was 18.6%. Factors associated with reduced DFS were liver tumor size > 5 cm (hazard ratio (HR) = 2.02) and positive surgical margin (HR = 2.33). The overall median survival after hepatic resection was 22.3 months and 5-year actuarial OS was 20.5%. Risk factors associated with worse overall survival included synchronous disease (HR = 4.09), hepatic metastasis > 5 cm (HR = 1.71) and positive surgical resection margin (HR = 1.83).
  
  
  CONCLUSIONS
  The majority of patients will recur following hepatic resection of SCC. Long-term survival, however, can be achieved following surgical resection of SCC liver metastasis, especially in patients who present with limited metachronous disease amenable to margin negative resection.
authors.affiliation: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Gleisner
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: Robert C
authors.initials: RC
authors.lastname: Martin
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Tanabe
authors.forename: James S
authors.initials: JS
authors.lastname: Michaelson
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Dominque
authors.initials: D
authors.lastname: Elias
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000401:mortality / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004564:Electrocoagulation; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011379:Prognosis; D019233:Retreatment; D014481:United States