Rates and Patterns of Recurrence Following Curative Intent Surgery for Colorectal Liver Metastases: an International Multi-institutional Analysis of 1512 Patients
*Timothy M Pawlik1, *Mechteld de Jong1, *Carlo Pulitano2, *Dario Ribero3, *Jennifer Strub4, *Gilles Mentha4, *Lorenzo Capussotti3, *Michael A Choti1
1Johns Hopkins, Baltimore, MD;2Vita-Salute San Raffaele University, Milan, Italy3Unit of Hepato-Biliary-Pancreatic Surgery, A.O. Ordine Mauriziano, Torino, Italy4University Hospitals of Geneva, Geneva, Switzerland
OBJECTIVE(S): To investigate rates and patterns of recurrence, as well as recurrence-free survival(RFS), in patients following curative intent surgery(CIS) for colorectal liver metastases(CRLM).
METHODS: 1512 patients treated with CIS for CRLM between 1982-2008 were identified from an international multi-institutional database. Clinical and pathologic data were evaluated with uni- and multivariate analyses.
RESULTS: At time of initial CIS, 1365(90%) patients underwent hepatic resection(HR), 29(2%) RFA, and 118(8%) HR+RFA. Pre-operative and adjuvant chemotherapy was administered to 692(46%) and 790(52%) patients, respectively. While 5-year overall survival was 47%, 928(61%) patients recurred with a median RFS time of 12.9 months. First recurrence site was intrahepatic only (43%), extrahepatic only (36%), intra- and extra-hepatic (21%). There was no difference in RFS based on site of recurrence (intrahepatic: 12.9 months; extrahepatic 12.6 months; intra- and extrahepatic: 12.2 month;P>0.05). The most common site of extrahepatic recurrence was the lung (42%). Receipt of adjuvant chemotherapy decreased overall recurrence risk (OR=0.61;P=0.007), while tumor size (OR=1.7;P=0.04 ) and R1 margin (OR=5.9;P=0.04) was predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat CIS for recurrent disease(Table).
CONCLUSIONS: While 5-year survival following CIS for CRLM approaches 50%, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed equally among intrahepatic, extrahepatic, and intra- plus extrahepatic sites. Patients undergoing repeat CIS have similar patterns of recurrence and RFS time.
|1st Recurrence n = 928||2nd Recurrence n = 190||3rd Recurrence n = 59||4th Recurrence n = 12|
|RFS from last CIS, month||12.9||13.0||12.8||11.5|
|Type of Hepatic CIS, %|
|RFA +/- Resection||21||18||31||40|
|Site of Recurence, %|
|Intra- + Extrahepatic||21||29||39||33|