Prognosis of patients with a single compared to multiple colorectal cancer liver metastases after hepatic resection / 中华肝胆外科杂志

ABSTRACT

Objective:To compare the prognosis of patients with a single compared to multiple colorectal cancer liver metastases (CRLM) after hepatectomy.Methods:The clinical data of 490 patients with colorectal cancer liver metastases who underwent hepatectomy at Department of Hepatopancreatobiliary Surgery Ⅰ, Peking University Cancer Hospital & Institute from January 2006 to December 2016 were retrospectively studied. There were 314 males and 176 females. The median age was 58 years (range 21 to 83 years). There were 200 patients in the single liver metastasis group and 290 patients in the multiple liver metastases group. The tumor recurrence and survival outcomes on follow-up were analyzed. Survival curves were plotted using the Kaplan-Meier method. Both overall survival and disease-free survival between two groups were compared by the log-rank test. Univariate and multivariate Cox regression analyses were used to analyze independent risk factors of overall survival.Results:The 1-, 3-, 5-, 10-year overall survival rates for the single versus the multiple liver metastases groups were 92.5%, 58.6%, 51.0%, 38.8% versus 90.7%, 53.2%, 41.1%, 29.9%. The differences were significant ( P<0.05). The disease-free survival was also significantly better in the single than the multiple groups ( P<0.05). Cox multivariate analysis showed that right-sided primary colonic tumor, preoperative carbohydrate antigen 19-9 level ≥50 U/ml, and RAS mutant were independent factors influencing survival in patients with single liver metastasis; while primary colonic tumor N 1-2, liver metastases diameter ≥5 cm, and RAS mutant were independent factors influencing survival in patients with multiple tumors. If the three independent factors affecting overall survival of patients with multiple liver metastases were assigned 1 point for each factor, the number of patients with scores of 0, 1, 2, and 3 were 50, 145, 84, and 11, respectively. The long-term survival of patients with a low score (0, 1) was similar to those with a single liver metastasis (both P>0.05). However, patients with a high score (2, 3) showed significantly worse long-term survival when compared with patients with a single liver metastasis (both P<0.05). Conclusions:The prognosis of patients with single colorectal liver metastasis was better than those with multiple liver metastases after hepatectomy. For patients with multiple liver metastases with fewer associated risk factors, surgical resection could still result in long-term survival outcomes which were comparable to those patients with a single liver metastasis.