Pattern of tumour growth of the primary colon cancer predicts long-term outcome after resection of liver metastases.
OBJECTIVE
To identify significant predictive factors for overall survival (OS) and disease-free survival (DFS) after liver resection for colon cancer metastases, with special focus on features of the primary colon cancer, such as lymph node ratio (LNR), vascular invasion, and perineural invasion.


METHODS
Patients operated for colonic cancer liver metastases between 2006 and 2014 were included. Details on patient characteristics, the primary colon cancer operation and metastatic disease were collected. Multivariate analysis was performed to select predictive variables for OS and DFS.


RESULTS
Median OS and DFS were 67 and 20 months, respectively. 1-, 3- and 5-year OS were 97, 76, and 52%. 1-, 3- and 5-year DFS were 65, 42, and 37%. Multivariate analysis showed LNR to be an independent predictive factor for DFS but not for OS. Other identified predictive factors were vascular and perineural invasion of the primary colon cancer, size of the largest metastasis and severe complications after liver surgery for OS, and perineural invasion, number of liver metastases and preoperative CEA-level for DFS. Traditional N-stage was also considered to be an independent predictive factor for DFS in a separate multivariate analysis.


CONCLUSIONS
LNR and perineural invasion of the primary colon cancer can be used as a prognostic variable for DFS after a concomitant liver resection for colon cancer metastases. Vascular and perineural invasion of the primary colon cancer are predictive for OS.
a Department of Surgery , Clinical Sciences Lund, Lund University and Skåne University Hospital , Lund , Sweden ;
Lidewij
L
Spelt
b Department of Pathology , Skåne University Hospital , Lund , Sweden.
Agata
A
Sasor
a Department of Surgery , Clinical Sciences Lund, Lund University and Skåne University Hospital , Lund , Sweden ;
Daniel
D
Ansari
a Department of Surgery , Clinical Sciences Lund, Lund University and Skåne University Hospital , Lund , Sweden ;
Roland
R
Andersson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome
Colonic neoplasms; disease-free survival; liver resection; lymph nodes; metastasis; survival analysis