title: A prognostic system applicable to patients with resectable liver metastasis from colorectal carcinoma staged by positron emission tomography with [18F]fluoro-2-deoxy-D-glucose: role of primary tumor variables.
abstract: BACKGROUND
  The purpose of this study was to develop a prognostic system applicable to patients with hepatic metastasis from colorectal cancer in whom extrahepatic disease was excluded by preoperative PET with [(18)F]fluoro-2-deoxy-D-glucose (FDG-PET). Data from two institutions were analyzed separately and together to improve general applicability of results.
  
  
  METHODS
  Data were analyzed for 285 consecutive patients undergoing liver resection for colorectal metastases from 1995 to 2005 at 2 institutions routinely using preoperative FDG-PET with. Fifteen clinicopathologic variables of the primary and secondary tumors were examined to identify factors predictive of survival.
  
  
  RESULTS
  Outcomes were correlated with poorly differentiated tumor grade in both data sets. Because patients with poorly differentiated tumors comprised a small proportion (16%) of the population, patients with well-differentiated or moderately differentiated tumors were analyzed independently. In this subgroup, positive lymph node status in the primary colorectal tumor resection specimen was the only characteristic that predicted survival of patients in both institutions. Consequently, patients were sorted into three prognostic categories: poor tumor differentiation; well-differentiated or moderately differentiated tumors and node positive; and well-differentiated or moderately differentiated tumors and node negative. These groups had significantly different overall survival on Kaplan-Meier analysis (p=0.0014).
  
  
  CONCLUSIONS
  In patients with colorectal liver metastases staged with FDG-PET with overall survival can be predicted directly from data in the pathology report of the colorectal primary tumor. This study also indicates the need for new molecular tumor markers of prognosis to complement clinicopathologic markers if the goal of prediction of outcomes in individual patients is to be reached.
authors.affiliation: Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in Saint Louis, St Louis, MO 63110, USA.
authors.forename: Marcus C B
authors.initials: MC
authors.lastname: Tan
authors.forename: Eric T
authors.initials: ET
authors.lastname: Castaldo
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Chari
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Wright
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.forename: Dominique
authors.initials: D
authors.lastname: Delbeke
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D014745:Viloxazine
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D014745:Viloxazine