Maximum Diameter and Number of Tumors as a New Prognostic Indicator of Colorectal Liver Metastases

Abstract

Abstract. Background: Surgical resection is currently considered the only potentially curative option as a treatment strategy of colorectal liver metastases (CRLM). Patients with MDN ≥30 had shown significantly poorer prognosis than patients with MDN <30 in OS and relapse-free survival (RFS). Conclusion: MDN ≥30 is an independent prognostic factor of survival in patients with CRLM and optimal surgical criterion of hepatectomy for CRLM.The liver is the most common site of metastasis in patients with colorectal cancer (CRC) (1), with 15-25% of patients presenting synchronous colorectal liver metastases (CRLM) (2). In addition, another 25-50% of patients develop subsequent metachronous metastases during the course of the disease (2, 3). Surgical resection is currently considered the only potentially curative option for patients with metastatic CRC confined to the liver (4, 5), and is associated with a 5-year overall survival (OS) rate of 37-58% (6). However, only 15-30% of patients with liver metastases may be initially resectable (7,8), but the criteria for selection of resectable CRLM remain unclear.According to Nordlinger et al., patients with CRLM have been classified into three clinical categories: (i) patients with resectable metastatic disease; (ii) patients with metastatic disease that is not optimally resectable (tumor size >5 cm, >4 metastases, synchronous CRLM, primary lymph node (LN)-positive, positive tumor markers and/or technically difficult) and (iii) patients unlikely to ever become resectable (9). Neoadjuvant chemotherapy was recommended for patients with resectable and unresectable CRLM, whereas first-line surgical resection was recommended only for patients with solitary metastases ≤2 cm and good prognostic features (10). In the European Society for Medical Oncology (ESMO) consensus guidelines for the management of patients with CRLM, patients were categorized by technical and oncological criteria. Oncological categories include (i) concomitant extrahepatic disease; (ii) number of lesions ≥5; (iii) tumor progression, with no mention of tumor size (11). However, clear criteria of surgical resection for CRLM have never been established.On the other hand, in hepatocellular carcinoma, the Milan criteria are used for a simple selection for liver transplantation around the world. The adaptation of liver transplantation was limited to one lesion smaller than 5 cm or up to 3 lesions smaller than 3 cm, and it is representing an approximate volume of tumor. In CRLM, simple criteria, using tumor number and size are required.Perioperative or neoadjuvant chemotherapy with various agents, alone or in combination, is the standard of care for most patients with CRLM (12, 13). Neoadjuvant chemotherapy in patients with initially unresectable CRLM can reduce metastasis sizes, converting initially unresectable to resectable lesions (conversion treatment) (9), making systemic chemotherapy in combination with liver resection an accepted 419

Total tumour volume as a prognostic factor in patients with resectable colorectal cancer liver metastases

“…Primary tumour factors (such as tumour site, invasiveness of the lesion and lymph node metastasis status) and preoperative factors (such as carcinoembryonic antigen (CEA) level, number of metastases and tumour size) are associated with patient outcomes after hepatic resection for CRLM. Most preoperative factors may be related to the total tumour volume (TTV) in the liver.…”

Prognostic value of preoperative carcinoembryonic antigen/tumor size in rectal cancer

“…Using tumor size to adjust and improve the prognostic value of tumor marker is not uncommon, such as prostate specific antigen density and tumor-infiltrating CD8+ T-cell density[14,15]. Maximum tumor diameter is also a prognostic indicator for some solid tumors including prostate cancer and colorectal liver metastases[16,17]. While the volume-adjusted prostate-specific antigen has been widely studied as a useful marker in prostate cancer[18,19], whether the combination of CEA level and tumor size serves as a novel prognostic factor for rectal cancer remains unresolved.…”

A Score to Identify Patients with Brain Metastases from Colorectal Cancer Who May Benefit from Whole-brain Radiotherapy in Addition to Stereotactic Radiosurgery/Radiotherapy

“…A number of studies have been performed in recent years in order to improve the prognoses of patients with colorectal cancer with both primary and metastatic disease (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). The number of patients with colorectal cancer presenting with brain metastases is quite small but will likely increase in the future due to improvement in survival of such patients (1).…”