title: Long-term outcomes after hepatic resection for colorectal metastases in young patients.
abstract: BACKGROUND
  Long-term outcomes after hepatectomy for colorectal liver metastases in relatively young patients are still unknown. The aim of the current study was to evaluate long-term outcomes in patients < or = 40 years old, and to compare them with patients >40 years old.
  
  
  METHODS
  All consecutive patients who underwent hepatectomy for colorectal liver metastases at the authors' hospital between 1990 and 2006 were included in the study. Patients < or = 40 years old were compared with all other patients treated during the same period. Overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) rates were determined, and prognostic factors were identified.
  
  
  RESULTS
  In total, 806 patients underwent hepatectomy for colorectal liver metastases, of whom 56 (7%) were aged < or = 40 years. Among the young patients, more colorectal liver metastases were present at diagnosis, and they were more often diagnosed synchronous with the primary tumor. Five-year OS was 33% in young patients, compared with 51% in older patients (P = .12). Five-year PFS was 2% in young patients, compared with 16% in older patients (P < .001). DFS rates were comparable between the groups (17% vs 23%, P = .10). At multivariate analysis, age < or = 40 years was identified as an independent predictor of poor PFS.
  
  
  CONCLUSIONS
  In young patients, colorectal liver metastases seem to be more aggressive, with a trend toward lower OS, more disease recurrences, and a significantly shorter PFS after hepatectomy. However, DFS rates were comparable between young and older patients, owing to an aggressive multimodality treatment approach, consisting of chemotherapy and repeat surgery. Therefore, physicians should recognize the poor outcome of colorectal liver metastases in young patients and should consider an aggressive approach to diagnosis and early treatment.
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Haas
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wicherts
authors.forename: Chadi
authors.initials: C
authors.lastname: Salloum
authors.forename: Paola
authors.initials: P
authors.lastname: Andreani
authors.forename: Dobromir
authors.initials: D
authors.lastname: Sotirov
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D011300:Preoperative Care; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents