title: Detailed pathologic characteristics of the primary colorectal tumor independently predict outcome after hepatectomy for metastases.
abstract: BACKGROUND
  Outcome after hepatic resection for colorectal cancer liver metastases (CRLM) is heterogeneous and accurate predictors of survival are lacking. This study analyzes the prognostic relevance of pathologic details of the primary colorectal tumor in patients undergoing hepatic resection for CRLM.
  
  
  METHODS
  Retrospective review of a prospective database identified patients who underwent resection for CRLM. Clinicopathological variables were investigated and their association with outcome was analyzed.
  
  
  RESULTS
  From 1997-2007, 1,004 patients underwent hepatic resection for CRLM. The median follow-up was 59 months with a 5-year survival of 47%. Univariate analysis identified nine factors associated with poor survival; three of these related to the primary tumor: lymphovascular invasion (LVI, p<0.0001), perineural invasion (p=0.005), and degree of regional lymph node involvement (N0 vs. N1 vs. N2, p<0.0001). Multivariate analysis identified seven factors associated with poor survival, two of which related to the primary tumor: LVI (hazard ratio (HR) 1.3, 95% confidence interval (CI) 1.06-1.64, p=0.01) and degree of regional lymph node involvement [N1 (HR 1.3, 95% CI 1.04-1.69, p=0.02) vs. N2 (HR 1.7, 95% CI 1.27-2.21, p<0.0005)]. A significant decrease in survival along the spectrum of patients ranging from LVI negative/N0 to LVI positive/N2 was present. Patients who were LVI-positive/N2 had a median survival of 40 months compared with 74 months for patients who were LVI-negative/NO (p<0.0001).
  
  
  CONCLUSIONS
  Histopathologic details of the primary colorectal tumor, particularly LVI and the detailed assessment of the degree of lymph node involvement, are strong predictors of survival. Future biomarker studies should consider exploring factors related to the primary colorectal tumor.
authors: Department of Surgery, Division of Hepatopancreatobiliary Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Kenneth
authors: K
authors: Cardona
authors: Pedro
authors: P
authors: Mastrodomenico
authors: Francesco
authors: F
authors: D'Amico
authors: Jinru
authors: J
authors: Shia
authors: Mithat
authors: M
authors: Gönen
authors: Martin R
authors: MR
authors: Weiser
authors: Philip B
authors: PB
authors: Paty
authors: T Peter
authors: TP
authors: Kingham
authors: Peter J
authors: PJ
authors: Allen
authors: Ronald P
authors: RP
authors: De Matteo
authors: Yuman
authors: Y
authors: Fong
authors: William R
authors: WR
authors: Jarnagin
authors: Michael I
authors: MI
authors: D'Angelica
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D010525:Peripheral Nerves / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome