Propensity score-matched outcomes analysis of the liver-first approach for synchronous colorectal liver metastases
Background Liver resection before primary cancer resection is a novel strategy advocated for selected patients with synchronous colorectal liver metastases (sCRLM). This study measured outcomes in patients with sCRLM following a liver‐first or classical approach, and used a validated propensity scor...
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Published in | British journal of surgery Vol. 103; no. 5; pp. 600 - 606 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Chichester, UK
John Wiley & Sons, Ltd
01.04.2016
Oxford University Press |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Liver resection before primary cancer resection is a novel strategy advocated for selected patients with synchronous colorectal liver metastases (sCRLM). This study measured outcomes in patients with sCRLM following a liver‐first or classical approach, and used a validated propensity score.
Methods
Clinical, pathological and follow‐up data were collected prospectively from consecutive patients undergoing hepatic resection for sCRLM at a single centre (2004–2014). Cumulative disease‐free survival (DFS), cancer‐specific survival (CSS) and overall survival (OS) were calculated by means of Kaplan–Meier analysis. Survival differences were analysed in the whole cohort and in subgroups matched according to Basingstoke Predictive Index (BPI).
Results
Of 582 patients, 98 had a liver‐first and 467 a classical approach to treatment; 17 patients undergoing simultaneous bowel and liver resection were excluded. The median (i.q.r.) BPI was significantly higher in the liver‐first compared with the classical group: 8·5 (5–10) versus 8 (4–9) (P = 0·030). Median follow‐up was 34 months. The 5‐year DFS rate was lower in the liver‐first group than in the classical group (23 versus 45·6 per cent; P = 0·001), but there was no difference in 5‐year CSS (51 versus 53·8 per cent; P = 0·379) or OS (44 versus 49·6 per cent; P = 0·305). After matching for preoperative BPI, there was no difference in 5‐year DFS (37 versus 41·2 per cent for liver‐first versus classical approach; P = 0·083), CSS (51 versus 53·2 per cent; P = 0·616) or OS (47 versus 49·1 per cent; P = 0·846) rates.
Conclusion
Patients with sCRLM selected for a liver‐first approach had more oncologically advanced disease and a poorer prognosis. They had inferior cumulative DFS than those undergoing a classical approach, a difference negated by matching preoperative BPI.
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Bibliography: | istex:CEEFA7173F6799B22F70B38E82313E2CEFB7268D ark:/67375/WNG-LSBJ548M-5 ArticleID:BJS10099 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0007-1323 1365-2168 |
DOI: | 10.1002/bjs.10099 |