title: Impact of novel histopathological factors on the outcomes of liver surgery for colorectal cancer metastases.
abstract: BACKGROUND
  We evaluated the impacts of a series of novel histopathological factors on clinical-surgical outcomes and survival of patients who underwent surgery for colorectal cancer liver metastasis, with and without neoadjuvant chemotherapy.
  
  
  METHODS
  A prospective database including 150 consecutive patients who underwent 183 hepatic resections for metastatic colorectal cancer was evaluated. Among them, 74 (49.3%) received neoadjuvant chemotherapy before surgery. The histopathological factors studied were: a) microsatellitosis, b) type and pattern of tumour growth, c) nuclear grade and the number of mitoses/mm(2), d) perilesional pseudocapsule, e) intratumoural fibrosis, f) lesion cellularity, g) hypoxic-angiogenic perilesional growth pattern, and h) the tumour normal interface.
  
  
  RESULTS
  Three or more metastatic lesions, R1 resection margins, and <50% tumour necrosis were prognostic factors for a worse OS, but only the former was confirmed to be an independent prognostic factor in the multivariate analysis. Furthermore, tumour fibrosis <40% and cellularity >10% were predictive of a worse neoadjuvant therapy response, but these findings were not confirmed in the multivariate analysis. Finally, tumour necrosis <50%, cellularity >10%, and TNI >0.5 mm were prognostic factors for a worse DFS and AS in the univariate but not in the multivariate analysis.
  
  
  CONCLUSIONS
  Several factors seem to influence the outcomes of surgery for colorectal cancer liver metastasis, especially the number of the lesions, the margins of resection, the percentage of necrosis and fibrosis, as well as the cellularity and the TNI.
authors.affiliation: Hepatopancreatic-biliary Surgical Unit, Miguel Servet University Hospital, Zaragoza, Spain. Electronic address: almaley@telefonica.net.
authors.forename: A
authors.initials: A
authors.lastname: Serrablo
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Paliogiannis
authors.affiliation: Unit of Surgery, San Francesco Hospital, Nuoro, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pulighe
authors.affiliation: General Surgery Department of San Jorge Hospital, Huesca, Spain.
authors.forename: S Saudi-Moro
authors.initials: SS
authors.lastname: Moro
authors.affiliation: Hepatopancreatic-biliary Surgical Unit, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Borrego-Estella
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Attene
authors.affiliation: Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Scognamillo
authors.affiliation: Deparment of Pathology, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Hörndler
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D000069287:Capecitabine; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D000068818:Cetuximab / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000473:pathology*; D016208:Databases, Factual; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005355:Fibrosis; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006498:Hepatectomy; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D059146:Metastasectomy; D008940:Mitotic Index; D015999:Multivariate Analysis; D009336:Necrosis; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010071:Oxaloacetates; D000077544:Panitumumab; D011379:Prognosis; D012189:Retrospective Studies; D047368:Tumor Burden
chemical_list: D000911:Antibodies, Monoclonal; D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D000077544:Panitumumab; D000068818:Cetuximab; D002955:Leucovorin; D005472:Fluorouracil
keywords: Chemotherapy; Colorectal cancer; Liver; Metastasis; Neoadjuvant; Surgery