title: FDG-PET-CT is effective in selecting patients with poor long term survivals for colorectal liver metastases.
abstract: OBJECTIVE
  Having incorporated PET-CT as part of the staging process for colorectal liver metastases (CRLM) in our unit since 2008, this study aims to evaluate the survival outcomes of all patients managed by our specialist multi-disciplinary team (MDT).
  
  
  METHODS
  All patients with colorectal liver metastases referred to a single liver MDT between 2008 and 2011 were examined. Overall survival (OS) for palliative groups due to occult extrahepatic disease detected by PET-CT (A) and those upfront palliative patients with extensive multi-site disease as identified on baseline CT or disease progression during chemotherapy (B), and resected (C) groups were evaluated and compared. Different extents of occult extrahepatic disease as characterised by PET-CT were also compared.
  
  
  RESULTS
  532 patients were included in the study. Median OS for group A (n = 80), B (n = 161) and C (n = 291) were 10.9, 12.0 and 46.7 months, with a 5-year OS approaching 6.5%, 6.1% and 43.0% respectively. There were significant differences in OS of C vs. A & B (p < 0.001). Single compartment metastases had a significant better survival outcomes than non-torso metastases (p = 0.04).
  
  
  CONCLUSIONS
  This is the first report of OS of patients with CRLM excluded from surgery on the basis of PET-CT. We have confirmed that PET-CT is effective in selecting patients with occult extrahepatic disease, which has poor survival outcomes. However, a subgroup with single compartment extrahepatic disease has a better than expected outcome.
authors.affiliation: Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. Electronic address: vincentyip@doctors.org.uk.
authors.forename: V S
authors.initials: VS
authors.lastname: Yip
authors.affiliation: Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.affiliation: Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
authors.forename: S W
authors.initials: SW
authors.lastname: Fenwick
authors.affiliation: Department of Radiology, University Hospital Aintree, Liverpool L9 7AL, UK.
authors.forename: H
authors.initials: H
authors.lastname: Wieshmann
authors.affiliation: Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
authors.forename: T
authors.initials: T
authors.lastname: Athwal
authors.affiliation: Liverpool Hepatobiliary Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. Electronic address: hassan.malik@aintree.nhs.uk.
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D033183:Interdisciplinary Communication; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D010348:Patient Care Team; D018579:Patient Selection; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012042:Registries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Colorectal liver metastases; PET-CT; Radiology; Survival outcomes