title: Risk factors for the development of metachronous liver metastasis in colorectal cancer patients after curative resection.
abstract: BACKGROUND
  Metachronous liver metastasis (MLM) occurs in 20-40% of colorectal cancer (CRC) patients following surgical treatment. The aim of the present study was to determine the risk factors affecting the development of MLM in CRC patients following curative resection.
  
  
  METHODS
  A total of 1,356 patients who underwent curative intent resection for CRC were retrospectively studied. Of these patients, those who with 30 days postoperative mortality (n=23), incomplete medical record (n=32), synchronous liver metastasis (n=148) and UICC stage IV (n=54) were excluded, and finally 1,099 patients were analyzed, including 977 patients without liver metastasis and 122 patients with MLM-only. Clinical and pathological records for each patient were reviewed from medical charts. The clinicopathologic characteristics of 1,099 patients were investigated.
  
  
  RESULTS
  The median timing of developing MLM was 13 months with a range of 4 to 79 months. Univariate analysis identified that preoperative serum carcinoembryonic antigen (CEA) level, depth of invasion, lymph nodes metastasis, vascular invasion, and perineural invasion were significantly correlated with the development of MLM (all P<0.05). Meanwhile, a multivariate analysis showed that preoperative serum carcinoembryonic antigen (CEA) level>5 ng/ml (Odds Ratio [OR]=1.591; 95% Confidence Interval [CI], 1.065-2.377; P=0.024), tumor depth (OR=2.294; 95% CI, 1.103-4.768; P=0.026), positive lymph node metastasis (OR=2.004; 95% CI, 1.324-3.031; P=0.001) and positive vascular invasion (OR=1.872; 95% CI, 1.225-2.861; P=0.004) were independent prognostic factors contributing to the occurrence of MLM.
  
  
  CONCLUSIONS
  The present study demonstrates that preoperative serum CEA level, tumor depth, lymph node metastasis, and positive vascular invasion could affect the occurrence of MLM in CRC patients following curative resection, and thus could help to define these high-risk patients who would benefit from enhanced surveillance and therapeutic program(s).
authors.affiliation: Division of Hepatopancreatobiliary Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan. chuangsc@cc.kmu.edu.tw
authors.forename: Shih-Chang
authors.initials: SC
authors.lastname: Chuang
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Su
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lu
authors.forename: Hung-Te
authors.initials: HT
authors.lastname: Hsu
authors.forename: Li-Chu
authors.initials: LC
authors.lastname: Sun
authors.forename: Ying-Ling
authors.initials: YL
authors.lastname: Shih
authors.forename: Chen-Guo
authors.initials: CG
authors.lastname: Ker
authors.forename: Jan-Sing
authors.initials: JS
authors.lastname: Hsieh
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
authors.forename: Jaw-Yuan
authors.initials: JY
authors.lastname: Wang
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000556:secondary; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors