Prognostic factors in patients with unresectable liver metastases from colorectal cancer

ABSTRACT

To determine the prognostic factors in patients with unresectable liver metastases from colorectal cancer. The medical records of 112 patients with unresectable liver metastasis from colorectal cancer were reviewed. The series included 39 patients who were treated with fluorouracil and 73 patients were treated with fluorourail and folinic acid [leucovorin]. Univaraite and multivariate analyses of the prognostic factors were done using the Cox proportional hazard model. Survival curves were plotted using the Kaplan-Meier method. The actuarial overall survival [OS] for the whole series was 64.2% at one year and 29.5% at two years, while the progression-free survival [PFS] was 47.2% at one year and dropped to 12.5% at two years. Several significant factors were identified by univariate analysis. These factors were; age, performance status, surgical resection of the primary tumour, extent of liver metastases [distribution, number and size of the largest liver deposit], CEA level, liver enzymes, total bilirubin, prothrombin time, extrahepatic disease, time to diagnosis of liver metastases, and response to chemotherapy. The modulation of fluorouracil by folinic acid markedly increased the overall response rate [RR], 34.2% versus 17.9% for fluorouracil alone [p=0.291], but with no significant impact on survival, 32.2% versus 25.0% two year OS, respectively. In multivariate analysis five independent determinants of OS were identified. Factors that had an adverse effect on survival were in the following order size of the largest metastatic liver deposit equal to or more than 5 cm [Hazard ratio [HR]= 3,31, p=0.0001], time to diagnosis less than 24 months [HR-2.75, p-0.001], poor performance status [MR-2.60, p=0.01] and elevated bilirubin level [MR-1.7, p=0.05]. Surgical resection of the primary tumour was associated with improved survival [HR=0.34, p=0.01]. Our data elucidated the prognostic value of the size of liver metastases, time to diagnosis, performance status, serum bilirubin and surgical resection of the primary. The addition of folinic acid to fluorouracil markedly improved the response but with only a trend towards better survival