Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases.
BACKGROUND
Resection of colorectal liver metastases (CLMs) is potentially curative but the effect of tumour number on prognosis is uncertain. This study compared the prognosis after resection and/or ablation of between one and three, or four or more CLMs.


METHODS
A systematic literature review from January 2000 to June 2008 was performed. Study selection and data extraction were standardized, and analysis included assessment of methodological quality, heterogeneity and bias. Main outcomes were 3- and 5-year survival. A meta-analysis comparing radical treatment in the two groups was performed using the hazard ratio for overall survival.


RESULTS
Of 1307 studies screened, 46 (9934 patients) were included in the analysis. Methodological quality was variable, and there was significant heterogeneity and reporting bias. The overall 5-year survival rate after radical treatment ranged from 7 to 58 per cent. Pooled hazard ratio for overall survival was 1.67 (95 per cent confidence interval 1.43 to 1.95; P < 0.001). Median reported 5-year survival for patients with four or more CLMs was 17.1 per cent.


CONCLUSIONS
Radical treatment of more than three CLMs results in poorer overall survival. Nevertheless, 5-year survival is achievable and the number of lesions should not, of itself, be used to exclude patients from surgery.
Smith
M D
MD
Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
McCall
J L
JL
D015982:Bias; D015179:Colorectal Neoplasms / Q000401:mortality*; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis