ABSTRACT
BACKGROUND: The best management of liver metastases from colorectal cancer is still debated and little is known about the true impact of treatments on survival. MATERIALS AND METHODS: The study involved 122 patients (77 males), aged 64.0 ± 11.0 years (range: 27.8-86.1) at diagnosis of liver metastatization (synchronous in 59). All underwent chemotherapy and at least one procedure of radiofrequency ablation; 53 also had partial hepatic resections. Demographics, tumor characteristics and survival outcomes from liver metastatization were analyzed with univariate and multivariate techniques. This analysis was performed also taking into account relative survival as the best estimate of specific survival. RESULTS: The analysis with observed survival selected the categorized number of involved lymph nodes in the colorectal specimens as the only statistically significant predictor, while the analysis with relative survival also showed site of the primary tumor (above the sigmoid colon or otherwise) and number of liver metastases as significant factors. The standardized mortality ratio was 9.673 (95% CI: 7.668-11.663) and a total of 201.85 years of life were lost in comparison with the survival of the reference population. CONCLUSIONS: The computation of relative survival better than observed survival selected a more adequate number of predictors, making investigation of even limited series of patients with confounding factors reliable. The finding that prognosis was mainly dependent on the anatomical presentation of the primary tumor and of liver metastases instead of treatments could explain the still contrasting opinions on the role of the available therapies in this field.
Subject(s)
Adenocarcinoma/secondary , Adenocarcinoma/therapy , Antineoplastic Agents/therapeutic use , Catheter Ablation , Colorectal Neoplasms/pathology , Hepatectomy , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Metastasectomy/methods , Neoadjuvant Therapy , Adenocarcinoma/mortality , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/adverse effects , Catheter Ablation/adverse effects , Catheter Ablation/mortality , Chemotherapy, Adjuvant , Colorectal Neoplasms/mortality , Female , Hepatectomy/adverse effects , Hepatectomy/mortality , Humans , Kaplan-Meier Estimate , Liver Neoplasms/mortality , Lymphatic Metastasis , Male , Metastasectomy/adverse effects , Metastasectomy/mortality , Middle Aged , Multivariate Analysis , Neoadjuvant Therapy/adverse effects , Neoadjuvant Therapy/mortality , Radiotherapy, Adjuvant , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
The prognosis of patients with hepatic metastasis from breast cancer treated with systemic or regional chemotherapy is disappointing. When technically feasible, liver resection offers the best results. Eighteen patients out of 22 submitted to laparotomy underwent radical liver resection. Median follow-up from liver resection was 36 months. The median time interval between breast cancer diagnosis and disease recurrence was 35 months. Median disease-free survival and overall survival from liver resection were 66 and 74 months, respectively. Median survival time from breast cancer surgery was 88.5 months. Surgical treatment of liver metastases should be carried out on young and older patients alike when site of metastases is the liver alone. Neoadjuvant treatment and preoperative diagnostic laparoscopy should be planned in future experience.
