Metachronous Colorectal Liver Metastases Has Better Prognosis - Is It True?

Abstract

BACKGROUND: Liver metastases from colorectal cancer are an important public health problem due to the increasing incidence of colorectal cancer worldwide. Synchronous colorectal liver metastasis has been associated with worse survival, but this prognosis is controversial. OBJECTIVE: The objective of this study was to evaluate the recurrence-free survival and overall survival between groups of patients with metachronous and synchronous colorectal hepatic metastasis. METHODS: This was a retrospective analysis of medical records of patients with colorectal liver metastases seen from 2013 to 2016, divided into a metachronous and a synchronous group. The Cox regression model and the Kaplan-Meier method with log-rank test were used to compare survival between groups. RESULTS: The mean recurrence-free survival was 9.75 months and 50% at 1 year in the metachronous group and 19.73 months and 63.3% at 1 year in the synchronous group. The mean overall survival was 20.00 months and 6.2% at 3 years in the metachronous group and 30.39 months and 31.6% at 3 years in the synchronous group. Patients with metachronous hepatic metastasis presented worse overall survival in multivariate analysis. The use of biological drugs combined with chemotherapy was related to the best overall survival prognosis. CONCLUSION: Metachronous colorectal hepatic metastasis was associated with a worse prognosis for overall survival. There was no difference in recurrence-free survival between metachronous and synchronous metastases.

Which patients are prone to suffer liver metastasis? A review of risk factors of metachronous liver metastasis of colorectal cancer

“…Ueno et al [ 149 ] defined metachronous liver metastasis as 12 months after primary surgery. Quireze et al [ 12 ] and Mekenkamp el at. [ 14 ] proposed 6 months after the initial diagnosis of primary CRC as the time of diagnosis with metachronous liver metastasis.…”

“…A large number of studies have demonstrated that patients with liver metastasis at the initial diagnosis have a poorer prognosis than those with metachronous liver metastasis [ 11 , 12 ]. Even among patients undergoing repeated hepatectomies [ 13 ], MST of metachronous metastasis remains superior to synchronous metastasis.…”

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

“…When evaluating the survival curves, it is important to remember that synchronous CRLMs will have decreased survival when compared to metachronous lesions. As a result, our survival may seem unfairly decreased in the minimally invasive groups, particularly the LLR group [ 23 , 24 , 25 , 26 , 27 ]. Additionally, although there was a tendency for the Pringle maneuver to be more commonly used after OLR, this was not statistically significant, and furthermore, studies have shown that utilization of this technique does not seem to influence survival [ 28 ].…”

Metastatic colorectal cancer. Evolution of treatment strategies: surgeons’ point of view

“…приводится следующая интерпретация поражения метастазами отдаленных органов: М1а -наличие отдаленных метастазов в 1 органе, М1b -наличие отдаленных метастазов в 2 органах, М1с -наличие только метаста-зов по брюшине или также в других органах и структурах. Известно, что прогноз у больных с синхронными метастазами печени хуже, чем у больных с отсроченным появлением метастазов в печени после удаления первичной опухоли, однако на сегодняшний день имеются данные об отсутствии различий в общей выживаемости (ОВ) вне зависимости от времени метастазирования [7].…”