Prognostic Factors Change Over Time After Hepatectomy for Colorectal Liver Metastases

Abstract

The impact of genetic, surgery-related, and clinicopathologic factors on OS and CS3 changed dramatically over time. Specifically, BRAF mutation status dominated prognosis in the first year, whereas positive surgical margins and resected extrahepatic disease determined prognosis thereafter.

R1 resection of colorectal liver metastasis – What is the cost of marginal resection?

“…Moreover, data regarding tumor biology such as the mutation status of KRAS, NRAS, BRAF and others is lacking. This might substantially influence the analysis, as was recently shown by others . Beyond These faults, our data may support the assumption that in the modern era of CRLM treatment, an aggressive surgical attitude, in combination with multiple line systemic therapy, may prolong patient's lives, even if an R0 resection cannot be achieved.…”

“…This might substantially influence the analysis, as was recently shown by others. 19,20 Beyond These faults, our data may support the assumption that in the modern era of CRLM treatment, an aggressive surgical attitude, in combination with multiple line systemic therapy, may prolong patient's lives, even if an R0 resection cannot be achieved. As long as the surgical risk in a given case is acceptable, and a complete macroscopic resection, leaving the patient with "no evidence of disease" is feasible, it may be worthwhile to offer surgery, even if an R0 is not realistic.…”

“…Another new concept differentiates R1 at the liver parenchyma from R1 at the interphase with major vessels inside the liver . Current prognostic models of CRLM resection put significant weight on clinical and pathological features and molecular markers of tumor biology . In spite of this multitude of data, the consequences of performing an R1 resection, in cases in which an R0 resection cannot be achieved, are still under considerable debate.…”

“…18 Current prognostic models of CRLM resection put significant weight on clinical and pathological features and molecular markers of tumor biology. 19,20 In spite of this multitude of data, the consequences of performing an R1 resection, in cases in which an R0 resection cannot be achieved, are still under considerable debate. In this report, we characterize the patients that had an R1 resection, and evaluate their perioperative course and long-term outcomes, compared with those who achieved an R0 resection.…”

Mutation status and surgical selection

“…This implies that wild‐type tumors have a benign biologic behavior that justifies such an approach. However, a recent study by the author's group questioned the prognostic importance of KRAS mutational status and its use as the only variable to inform surgical management . Employing a conditional survival analysis, we found that the impact of KRAS on survival appeared moderate at best and comparable with that of traditional clinicopathologic factors (CEA levels, lymph node metastasis, or multiple tumors).…”