Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection
Abstract Background Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence. Methods Data were collected retrospecti...
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doaj-dd833d5d737648db9a7bd350554ae72d2021-08-22T11:10:37ZengBMCBMC Surgery1471-24822021-08-0121111010.1186/s12893-021-01323-yRecurrent colorectal liver metastasis patients could benefit from repeat hepatic resectionWei Liu0Jia-Ming Liu1Kun Wang2Hong-Wei Wang3Bao-Cai Xing4Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and InstituteHepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and InstituteHepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and InstituteHepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and InstituteHepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and InstituteAbstract Background Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence. Methods Data were collected retrospectively from CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution.
A nomogram predicting overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curve. Results Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated and had resectable and liver-limited disease. Among them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients received only systemic chemotherapy. Multivariable analysis identified primary lymph node positivity, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment as independent risk factors for survival outcomes. Integrating these five variables, the nomogram presented a good concordance index of 0.707. Compared with patients who received only systemic chemotherapy, radical local treatment did not significantly improve survival outcomes (median OS: 21 vs. 15 months, p = 0.126) in the high-risk group (total score ≥ 13). Conclusion Radical local treatment improved the survival of recurrent CRLM patients. The proposed model facilitates personalized assessments of prognosis for patients who develop first recurrence in the liver.https://doi.org/10.1186/s12893-021-01323-yCRLMRecurrenceRepeatResectionRFA |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Wei Liu Jia-Ming Liu Kun Wang Hong-Wei Wang Bao-Cai Xing |
spellingShingle |
Wei Liu Jia-Ming Liu Kun Wang Hong-Wei Wang Bao-Cai Xing Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection BMC Surgery CRLM Recurrence Repeat Resection RFA |
author_facet |
Wei Liu Jia-Ming Liu Kun Wang Hong-Wei Wang Bao-Cai Xing |
author_sort |
Wei Liu |
title |
Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection |
title_short |
Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection |
title_full |
Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection |
title_fullStr |
Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection |
title_full_unstemmed |
Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection |
title_sort |
recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection |
publisher |
BMC |
series |
BMC Surgery |
issn |
1471-2482 |
publishDate |
2021-08-01 |
description |
Abstract Background Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence. Methods Data were collected retrospectively from CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution.
A nomogram predicting overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curve. Results Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated and had resectable and liver-limited disease. Among them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients received only systemic chemotherapy. Multivariable analysis identified primary lymph node positivity, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment as independent risk factors for survival outcomes. Integrating these five variables, the nomogram presented a good concordance index of 0.707. Compared with patients who received only systemic chemotherapy, radical local treatment did not significantly improve survival outcomes (median OS: 21 vs. 15 months, p = 0.126) in the high-risk group (total score ≥ 13). Conclusion Radical local treatment improved the survival of recurrent CRLM patients. The proposed model facilitates personalized assessments of prognosis for patients who develop first recurrence in the liver. |
topic |
CRLM Recurrence Repeat Resection RFA |
url |
https://doi.org/10.1186/s12893-021-01323-y |
work_keys_str_mv |
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