Predictors of early recurrence and long-term survival in patients after resection for colorectal cancer liver metastases with a low-risk on clinical risk score / 中华肝胆外科杂志

ABSTRACT

Objective:To study the related factors of early recurrence and long-term survival after hepatectomy for patients with colorectal cancer liver metastases (CRLM) with a low-risk on clinical risk score (CRS).Methods:The clinicopathological data of 983 consecutive patients with CRLM who underwent liver resection at Department of Hepatopanereatobiliary Surgery Ⅰ, Peking University Cancer Hospital & Institute between January 2000 and November 2018 were studied retrospectively. A total of 420 patients with a CRS of 0-2 met the inclusion criteria of this study. There were 272 males and 148 females, aged from 21 to 83 years, with a median age 59 years. Univariate and multivariate logistic regression analyses were performed to identify the related factors associated with early recurrence. Survival curves were generated by the Kaplan-Meier method and compared by the log-rank test.Results:Of 420 patients, 272(64.8%) patients developed recurrence, with 163 patients developing early recurrence. Multivariate analysis revealed synchronous liver metastasis ( OR=1.587, 95% CI 1.021-2.467), number of liver metastases ≥3( OR=1.904, 95% CI 1.091-3.324) and RAS mutation ( OR=1.774, 95% CI 1.157-2.270) were independent risk factors of early recurrence. The 5-year overall survival of patients with early recurrence was significantly lower than those with non-early recurrence (33.4% vs 71.1%, P<0.05). For the 163 patients with early recurrence, 41(25.2%) underwent repeat liver resection. When compared with the remaining 122(74.8%) patients who underwent non-resectional treatment, these 41 patients had a significantly higher 5-year overall survival rate (63.5% vs 21.1%, P<0.05). Conclusions:In patients with colorectal cancer liver metastases with a low risk on CRS, the independent risk factors for early recurrence were synchronous liver metastasis, number of liver metastases ≥3, and RAS mutation. Re-resection of early recurrent disease achieved better survival outcomes.