Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center

Abstract

-Context -Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. Objectives -To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. Method -This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. Results -During the period analyzed, 209 procedures were performed on 170 patients. Postoperative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. Conclusion -Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients showed similar results to those pointed in international series. The occurrence of major postoperative complications appears to be able to compromise overall survival and further investigation in needed in this topic. HEADINGS -Colorectal neoplasm. Liver neoplasms, secondary. Hepatectomy. Prognosis.

Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis

“…All identified studies were observational design studies involving a total of 10621 patients. Seven studies were from USA [5, 7, 9, 16, 21, 22, 24], four from Italy [4, 8, 12, 13], three from Japan [3, 14, 18], two from UK [11, 25], two from Germany [20, 23], one from Sweden [2], one from France [6], one from Spain [10], one from Brazil [15], one from China [17], one from Canada [19], and one from the Netherlands [26]. The blood product transfusion rate was highly variable across studies ranging from 13.5% to 91.5%.…”

“…The impact of PBT on OS and disease-free survival (DFS) was evaluated in 21 [2–9, 11, 12, 15–19, 21–26] and 11 [6, 8, 11, 12, 15–17, 19, 20, 22] studies, respectively. The 5-year OS and DFS of transfused patients ranged from 21.5% to 62.7% and 14.7% to 42% respectively vs .…”

Predictors of long‐term survival in patients with hepatic resection of colorectal metastases: Analysis of a Brazilian Cancer Center Cohort

“…Survival rates 5 and 10 years after diagnosis are approximately 59% and 20%, respectively in American center, 4,5 though no studies have assessed survival rates in South American populations. Our previous work assesses short‐term survival in a South American colorectal cancer population and found a 5‐year overall survival of 64.9%, 6 though long‐term survival has not yet been investigated. Therefore, a comprehensive study of the factors associated with long‐term survival in South American populations is needed to improve surgical selection approaches and decrease morbidity and futile locoregional treatments 7 …”

Management of Liver Metastasis of Colorectal Cancer

“…Tumor size, positive surgical margins, lymphnode involvement, lymphovascular invasion, carcinoembrionic antigen (CEA) level, poor histological differentiation and tumor budding were considered the most important prognostic factors both in colorectal cancer and in metastatic colorectal cancer (mCRC) [6] . Studies have shown that both higher prediagnosis plasma levels of vitamin D and regular aspirin use are associated with improved outcomes in patients with advanced colorectal disease [7] . A high body mass index (BMI) and alack of physical exercise are also associated with both the development of colorectal cancer and poorer outcomes [8] .…”