Development of a Prognostic Model Based on the Analysis of 1452 Patients with Non-Colorectal Non-Endocrine Hepatic Metastases Treated with Hepatic Resection
René Adam, M.D., Ph.D.*, Laurence Chiche, M.D.*, Dominique Elias, M.D.*, Rémy Salmon, M.D.*, Michel Rivoire, M.D.*, Daniel Jaeck, M.D.*, Jean Saric, M.D.*, Yves Patrice Le Treut, M.D.*, Jacques Belghiti, M.D.*, Georges Mantion, M.D.*
Hospital Paul Brousse, Villejuif, France
Sponsored by: Henri Bismuth, M.D.
Objective: The place of hepatic resection (HR) in the treatment of non-colorectal non-endocrine liver metastases (NCNELM) remains controversial, primarily due to limited patient numbers assessed in previously published reports. By including a large number of patients this study was designed to determine the efficacy of HR in patients with NCNELM.
Methods: A multivariate risk model was developed by analyzing prognostic factors and long-term outcomes in 1452 patients with NCNELM treated with HR at 41 centers from 1983 to 2004.
Results: Hepatic metastases were solitary in 56% and unilateral in 71% (mean diameter: 50.5 mm). Extrahepatic metastases were present in 22%. The most common primary sites were breast (32%), gastrointestinal (16%), and urological (14%). The most common histologies were adenocarcinoma (66%), GIST/sarcoma (13.5%) and melanoma (13%). R0 resection was achieved in 83% of cases with a 60-day mortality rate of 2.3% and a major complication rate of 21.5%.
Recurrences occurred in 67% of patients (liver: 24%; extrahepatic: 18%; both: 25%). Overall and disease-free survivals at 5 years were 36% and 21% and at 10 years were 23% and 15%, respectively. Poor prognostic factors included age >60 years, non-breast primary, melanoma or squamous histology, disease-free interval <12 months, extrahepatic metastases, major hepatectomy, and R2 resection (all P<=0.02). A prognostic model based on these factors effectively stratified patients into high-risk (>7 points, <10% 5-year survival), mid-risk (3-6 points, 20% 5-year survival) and low-risk (0-2 points, 45% 5-year survival) groups.
Conclusions: These data indicate that HR for NCNELM is safe and effective, with outcomes mainly dependent on primary tumor site and histology. For individual patients a statistical model, based on seven key prognostic factors, can predict long-term survival.
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