Determinants of survival in patients with unresectable colorectal liver metastases

Abstract

Prognostic indicators in 67 patients with unresectable colorectal liver metastases were analyzed. These patients were identified to have isolated hepatic metastases after extensive radiological evaluation and demonstrated good performance status without evidence of liver failure. Univariate analysis revealed 6 of 22 factors that were associated with survival: alkaline phosphatase (AP), lactic dehydrogenase (LDH), occult intra-abdominal extrahepatic disease, percent hepatic replacement by tumor (PHR), sex, and carcinoembryonic antigen (CEA). A multivariate analysis identified two independent factors that jointly influenced survival: AP and PHR. Patients with an AP greater than 175 U/liter had a greater than threefold relative risk of dying compared with patients with AP less than or equal to 175 U/liter (P = 0.0001). Patients with PHR II or III (25-75%, greater than 75%) also had a greater than threefold relative risk of dying compared with patients with PHR 1 (less than 25%; P = 0.0074). Our patient population is typical of that being entered into trials examining experimental therapies. Alkaline phosphatase and extent of liver involvement by tumor are significant prognostic indicators that should be accounted for in such studies.

Comparison of plasma prolactin and CEA in monitoring patients with adenocarcinoma of colon and rectum

“…Moreover, temporary, nonprogressive elevations of CEA were seen in 30% of patients, which is an extreme example of this phenomenon (Rittgers et al, 1978). Despite the lack of specificity for colon cancer, CEA demonstrated an excellent correlation in patients with colorectal liver metastases (Chu et al, 1982;DeBrauw et al, 1987;Lorenz et al, 1989;Chang et al, 1989). Our study confirms these findings with 100% score.…”

Prognostic variables in patients with advanced colorectal cancer treated with fluorouracil and leucovorin-based chemotherapy

“…Other significant factors influencing survival were found to be ALP [34,36,44], SGOT [44], 5' Nt 1451, LDH [24], and PS [24,38]. As was previously stated, it is believed that liver function tests reflect the extent of liver involvement, although other investigators showed that these variables were independent prognostic factors [45].…”

Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer

“…Several studies have reported the prognostic significance of LDH in patients with metastatic colorectal cancer (Chang et al, 1989;Kemeny et al, 1989;Steinberg et al, 1992;Fountzilas et al, 1996). Indeed, one study (Kemeny & Braun, 1983) described the importance of LDH as an independent predictor of survival in advanced colorectal carcinoma.…”

“…Other prognostic factors for colorectal cancer include age, tumor grade, tumor size and location, symptom duration, and vascular and neural invasion. More recently, other prognostic factors have been identified including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), serum albumin, alkaline phosphatase, lactate dehydrogenase (LDH), aspartate aminotransferase, gamma-glutamyl-transpeptidase, and performance status (Chang et al, 1989;Kouri et al, 1992;Steinberg et al, 1992;Wang et al, 2002;Yuste et al, 2003).…”