Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis

• Published in: Canadian Journal of Surgery Vol. 64; pp. S149 - S150
• Main Authors: Park, L, Daza, J, Li, V, Msallak, H, Zhang, B, Workneh, A, Faisal, S, Faisal, R, Fabbro, M, Gu, C, Claassen, M, Zuk, V, Hallet, J, Martel, G, Sapisochin, G, Serrano, P
• Format: Journal Article
• Language: English
• Published: Ottawa CMA Impact, Inc 01.12.2021
• Subjects: Colorectal cancer; Liver; Medical prognosis; Metastasis
• ISSN: 0008-428X; 1488-2310

Background: Despite high recurrence rates following liver resection for colorectal cancer liver metastasis (CRLM), there is a lack of robust evidence to guide clinical management in this setting. We aimed to define prognostic factors for survival in patients with recurrence following liver resection for CRLM. We also determined overall survival (OS) and disease-free survival (DFS) in patients who undergo curative treatment at the time of first recurrence following initial liver resection. Methods: This was a multi-institutional retrospective cohort study of consecutive patients who had disease recurrence following their first liver resection for CRLM. Recurrence was defined as metastatic disease following curative-intent therapy for the preceding recurrence. Multivariable Cox regression models were used to identify poor prognostic factors associated with survival. Using recursive partitioning on significant prognostic factors, patients were classified into low- and high-risk groups and compared using Kaplan-Meier curves and the log-rank test. Results: There were 471 patients included in this study. Prognostic factors associated with survival were (i) time to first recurrence less than 8.5 months after liver resection (hazard ratio [HR] 4.60, 95% confidence interval [CI] 2.46-8.59) and (ii) presence of extrahepatic disease at first liver resection (HR 2.95, 95% CI 1.30-6.71). The high-risk group (i.e., patients with time to recurrence < 8.5 mo or extrahepatic disease or both) had median OS of 40.5 months (95% CI 34.0-45.7) versus 64.7 months (95% CI 57.9-72.3) in the low-risk group. The mean DFS and OS following curative surgery at the time of first recurrence were 17.4 months (95% CI 15.2-19.5) and 53.2 months (95% CI 50.5-55.8), respectively. Conclusion: Extrahepatic disease at the time of first liver resection as well as short time to recurrence were identified as poor prognostic factors for patients with recurrence following liver resection. These results can guide tailoring of therapy to low- and high-risk patients.