title: Classifying the stage IV colorectal cancer: prognostic impact of radical resection for colorectal liver metastases and proposal for a new staging system.
abstract: Currently, there is no universally accepted system to classify the stage IV colorectal cancer. Here, we analyze the prognostic impact of radical resection for colorectal liver metastases and propose a new staging system for stage IV colorectal cancer. A retrospective review was undertaken of 126 consecutive patients who underwent surgical treatment for colorectal liver metastases from January 1997 to January 2004. Based on the overall survival rates (Kaplan-Meier method) and surgical outcomes, we propose a new staging system for stage IV colorectal cancer. Patients were divided into two groups: patients who underwent initial hepatic resections (R0 resection) for liver metastases (group 1, n = 22), and patients who underwent palliative resection for unresectable liver metastases (group 2, n = 104). The overall survival rates in group 1 at 1, 3, and 5 years were 68.2% (15/22), 40.9% (9/22), and 18.2% (4/22), respectively. The overall survival rates in group 2 at 1, 3, and 5 years were 54.8% (57/104), 16.3% (17/104), and 0% (0/104), respectively. There was a significant difference in overall survival rates between both groups (p < 0.05). Based on the study results, we propose a new staging system where all distant metastases are grouped within stage IV and subclassified into resectable (R0 resection) and unresectable stages. Curative surgical treatment is a critical prognostic factor in colorectal liver metastases. The proposed new staging system for stage IV colorectal cancer is simple and is clinically useful to estimate the prognosis.
authors.affiliation: Department of Colorectal Surgery, The Second Affiliated Hospital, Harbin Medical University, 246 Xuefu Road, Harbin, 150086, China.
authors.forename: Ying-Gang
authors.initials: YG
authors.lastname: Chen
authors.forename: Zheng
authors.initials: Z
authors.lastname: Liu
authors.forename: Xi-Shan
authors.initials: XS
authors.lastname: Wang
mesh_terms: D000368:Aged; D002272:Carcinoembryonic Antigen / Q000032:analysis; D015179:Colorectal Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D002272:Carcinoembryonic Antigen