title: Actual 10-year survival after resection of colorectal liver metastases defines cure.
abstract: OBJECTIVE
  Resection of colorectal liver metastases (CLM) in selected patients has evolved as the standard of care during the last 20 years. In the absence of prospective randomized clinical trials, a survival benefit has been deduced relative to historical controls based on actuarial data. There is now sufficient follow-up on a significant number of patients to address the curative intent of resecting CLM.
  
  
  METHODS
  Retrospective review of a prospectively maintained database was performed on patients who underwent resection of CLM from 1985 to 1994. Postoperative deaths were excluded. Disease-specific survival (DSS) was calculated from the time of hepatectomy using the Kaplan-Meier method.
  
  
  RESULTS
  There were 612 consecutive patients identified with 10-year follow-up. Median DSS was 44 months. There were 102 actual 10-year survivors. Ninety-nine (97%) of the 102 were disease free at last follow-up. Only one patient experienced a disease-specific death after 10 years of survival. In contrast, 34% of the 5-year survivors suffered a cancer-related death. Previously identified poor prognostic factors found among the 102 actual 10-year survivors included 7% synchronous disease, 36% disease-free interval less than 12 months, 25% bilobar metastases, 50% node-positive primary, 39% more than one metastasis, and 35% tumor size more than 5 cm.
  
  
  CONCLUSIONS
  Patients who survive 10 years appear to be cured of their disease, whereas approximately one third of actual 5-year survivors succumb to a cancer-related death. In well-selected patients, there is at least a one in six chance of cure after hepatectomy for CLM. The presence of poor prognostic factors does not preclude the possibility of long-term survival and cure.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. dangelim@mskcc.org
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Peter
authors.initials: P
authors.lastname: Kornprat
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Nancy
authors.initials: N
authors.lastname: Kemeny
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Blumgart
authors.forename: Michael
authors.initials: M
authors.lastname: D'Angelica
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome