Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer

Marcella Arru, Luca Aldrighetti, Renato Castoldi, Saverio Di Palo, Elena Orsenigo, Marco Stella, Carlo Pulitanò, Francesca Gavazzi, Gianfranco Ferla, Valerio Di Carlo, Carlo Staudacher

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Abstract

Background: The aim of this study was to analyze the prognostic factors associated with long-term outcome after liver resection for colorectal metastases. The retrospective analysis included 297 liver resections for colorectal metastases. Methods: The variables considered included disease stage, differentiation grade, site and nodal metastasis of the primary tumor, number and diameter of the lesions, time from primary cancer to metastasis, preoperative carcinoembryonic antigen (CEA) level, adjuvant chemotherapy, type of resection, intraoperative ultrasonography and portal clamping use, blood loss, transfusions, complications, hospitalization, surgical margins status, and a clinical risk score (MSKCC-CRS). Results: The univariate analysis revealed a significant difference (p <0.05) in overall 5-year survival rates depending on the differentiation grade, preoperative CEA >5 and >200 ng/ml, diameter of the lesion >5 cm, time from primary tumor to metastases >12 months, MSKCC-CRS >2. The multivariate analysis showed three independent negative prognostic factors: G3 or G4 grade, CEA >5 ng/ml, and high MSKCC-CRS. Conclusions: No single prognostic factor proved to be associated with a sufficiently disappointing outcome to exclude patients from liver resection. However, in the presence of some prognostic factors (G3-G4 differentiation, preoperative CEA >5 ng/ml, high MSKCC-CRS), enrollment of patients in trials exploring new adjuvant treatments is suggested to improve the outcome after surgery.

Original languageEnglish
Pages (from-to)93-103
Number of pages11
JournalWorld Journal of Surgery
Volume32
Issue number1
DOIs
Publication statusPublished - Jan 2008

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Colorectal Neoplasms
Neoplasm Metastasis
Carcinoembryonic Antigen
Survival
Liver
Neoplasms
Adjuvant Chemotherapy
Constriction
Blood Transfusion
Ultrasonography
Hospitalization
Multivariate Analysis
Therapeutics

ASJC Scopus subject areas

  • Surgery

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Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. / Arru, Marcella; Aldrighetti, Luca; Castoldi, Renato; Di Palo, Saverio; Orsenigo, Elena; Stella, Marco; Pulitanò, Carlo; Gavazzi, Francesca; Ferla, Gianfranco; Di Carlo, Valerio; Staudacher, Carlo.

In: World Journal of Surgery, Vol. 32, No. 1, 01.2008, p. 93-103.

Research output: Contribution to journalArticle

Arru, Marcella ; Aldrighetti, Luca ; Castoldi, Renato ; Di Palo, Saverio ; Orsenigo, Elena ; Stella, Marco ; Pulitanò, Carlo ; Gavazzi, Francesca ; Ferla, Gianfranco ; Di Carlo, Valerio ; Staudacher, Carlo. / Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. In: World Journal of Surgery. 2008 ; Vol. 32, No. 1. pp. 93-103.
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abstract = "Background: The aim of this study was to analyze the prognostic factors associated with long-term outcome after liver resection for colorectal metastases. The retrospective analysis included 297 liver resections for colorectal metastases. Methods: The variables considered included disease stage, differentiation grade, site and nodal metastasis of the primary tumor, number and diameter of the lesions, time from primary cancer to metastasis, preoperative carcinoembryonic antigen (CEA) level, adjuvant chemotherapy, type of resection, intraoperative ultrasonography and portal clamping use, blood loss, transfusions, complications, hospitalization, surgical margins status, and a clinical risk score (MSKCC-CRS). Results: The univariate analysis revealed a significant difference (p <0.05) in overall 5-year survival rates depending on the differentiation grade, preoperative CEA >5 and >200 ng/ml, diameter of the lesion >5 cm, time from primary tumor to metastases >12 months, MSKCC-CRS >2. The multivariate analysis showed three independent negative prognostic factors: G3 or G4 grade, CEA >5 ng/ml, and high MSKCC-CRS. Conclusions: No single prognostic factor proved to be associated with a sufficiently disappointing outcome to exclude patients from liver resection. However, in the presence of some prognostic factors (G3-G4 differentiation, preoperative CEA >5 ng/ml, high MSKCC-CRS), enrollment of patients in trials exploring new adjuvant treatments is suggested to improve the outcome after surgery.",
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AU - Castoldi, Renato

AU - Di Palo, Saverio

AU - Orsenigo, Elena

AU - Stella, Marco

AU - Pulitanò, Carlo

AU - Gavazzi, Francesca

AU - Ferla, Gianfranco

AU - Di Carlo, Valerio

AU - Staudacher, Carlo

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N2 - Background: The aim of this study was to analyze the prognostic factors associated with long-term outcome after liver resection for colorectal metastases. The retrospective analysis included 297 liver resections for colorectal metastases. Methods: The variables considered included disease stage, differentiation grade, site and nodal metastasis of the primary tumor, number and diameter of the lesions, time from primary cancer to metastasis, preoperative carcinoembryonic antigen (CEA) level, adjuvant chemotherapy, type of resection, intraoperative ultrasonography and portal clamping use, blood loss, transfusions, complications, hospitalization, surgical margins status, and a clinical risk score (MSKCC-CRS). Results: The univariate analysis revealed a significant difference (p <0.05) in overall 5-year survival rates depending on the differentiation grade, preoperative CEA >5 and >200 ng/ml, diameter of the lesion >5 cm, time from primary tumor to metastases >12 months, MSKCC-CRS >2. The multivariate analysis showed three independent negative prognostic factors: G3 or G4 grade, CEA >5 ng/ml, and high MSKCC-CRS. Conclusions: No single prognostic factor proved to be associated with a sufficiently disappointing outcome to exclude patients from liver resection. However, in the presence of some prognostic factors (G3-G4 differentiation, preoperative CEA >5 ng/ml, high MSKCC-CRS), enrollment of patients in trials exploring new adjuvant treatments is suggested to improve the outcome after surgery.

AB - Background: The aim of this study was to analyze the prognostic factors associated with long-term outcome after liver resection for colorectal metastases. The retrospective analysis included 297 liver resections for colorectal metastases. Methods: The variables considered included disease stage, differentiation grade, site and nodal metastasis of the primary tumor, number and diameter of the lesions, time from primary cancer to metastasis, preoperative carcinoembryonic antigen (CEA) level, adjuvant chemotherapy, type of resection, intraoperative ultrasonography and portal clamping use, blood loss, transfusions, complications, hospitalization, surgical margins status, and a clinical risk score (MSKCC-CRS). Results: The univariate analysis revealed a significant difference (p <0.05) in overall 5-year survival rates depending on the differentiation grade, preoperative CEA >5 and >200 ng/ml, diameter of the lesion >5 cm, time from primary tumor to metastases >12 months, MSKCC-CRS >2. The multivariate analysis showed three independent negative prognostic factors: G3 or G4 grade, CEA >5 ng/ml, and high MSKCC-CRS. Conclusions: No single prognostic factor proved to be associated with a sufficiently disappointing outcome to exclude patients from liver resection. However, in the presence of some prognostic factors (G3-G4 differentiation, preoperative CEA >5 ng/ml, high MSKCC-CRS), enrollment of patients in trials exploring new adjuvant treatments is suggested to improve the outcome after surgery.

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