Analysis of the prognosis of surgery for colorectal liver metastases by preoperative CT scan images. Could “Central Type” and “Budding phenomenon“ Be Prognostic Factors?

Abstract

Aims: To report overall and progression-free survival among patients who underwent synchronous resection of primary colorectal cancer and liver metastases with or without preoperative treatment. Methods: We performed a retrospective analysis of patients who underwent liver resection for synchronous colorectal metastases. We analyzed patient characteristics and baseline investigations following tumour board review. Recurrence and mortality were examined using Kaplan-Meier survival curves. Results: Between 2010 and 2017, 111 patients underwent liver resection for colorectal adenocarcinoma of which 33 patients had synchronous resection of primary and metastatic liver tumour. 10 patients underwent preoperative treatment and 23 patients had upfront surgery. Median age was 58.1 vs 65.8 years respectively (p=0.0086). 3-year and 5-year overall survival for all patients were 64.7% and 30.8%, respectively, with no difference between both groups (HR 1.971, 95%CI: 0.466-8.332, log rank test p=0.3). Patients with preoperative treatment had poorer progression-free survival (log rank test p=0.0527). Median progression-free survival was 12.2 months in pretreatment group vs 19.0 months for patients with upfront surgery. Patients with upfront surgery had fewer instances of extrahepatic recurrence compared to those with pretreatment (27.3% vs 87.5%, p=0.0198). More patients with pretreatment had rectal cancer (70.0% vs 4.35%, p=0.0002). The overall and progression-free survival for patients with rectal and colon cancer was similar.