Introduction
Patients and methods
Study population
Parameter | Unilobar liver metastases N = 100 | Bilobar liver metastases N = 70 |
p value |
---|---|---|---|
Agea
| 63 [41–79] | 59 [34–75] | 0.019 |
Gender | 0.266 | ||
Female | 44 (44 %) | 24 (34 %) | |
Male | 56 (56 %) | 46 (66 %) | |
Primary tumor | 0.755 | ||
Colon | 56 (56 %) | 41 (59 %) | |
Rectumb
| 44 (44 %) | 29 (41 %) | |
Neoadjuvant therapy | 0.116 | ||
Yes | 18 (18 %) | 6 (9 %) | |
No | 82 (82 %) | 64 (91 %) | |
T stage | 0.535 | ||
<3 | 19 (19 %) | 10 (14 %) | |
≥3 | 81 (81 %) | 60 (86 %) | |
Nodal status | 0.276 | ||
<1 | 52 (52 %) | 30 (43 %) | |
≥1 | 48 (48 %) | 40 (57 %) | |
Grading | 0.245 | ||
<3 | 90 (90 %) | 58 (83 %) | |
≥3 | 10 (10 %) | 12 (17 %) | |
Resection status | 0.083 | ||
0 | 99 (99 %) | 65 (93 %) | |
≥1 | 1 (1 %) | 5 (7 %) | |
UICC stage | 0.082 | ||
≤2 | 33 (33 %) | 17 (24 %) | |
3 | 26 (26 %) | 12 (17 %) | |
4 | 41 (41 %) | 41 (59 %) | |
Adjuvant chemotherapy | 0.136 | ||
Yes | 37 (37 %) | 18 (26 %) | |
No | 63 (63 %) | 52 (74 %) |
Staging procedures and treatment algorithm for CRLM
Statistical analysis
Results
Preoperative treatment
Parameter | Unilobar liver metastases N = 100 | Bilobar liver metastases N = 70 |
p value |
---|---|---|---|
No. of liver metastases preoperatively | <0.001 | ||
1 | 77 (77 %) | 15 (21 %)a
| |
>1 | 23 (23 %) | 55 (79 %) | |
Median number of liver metastases pretherapeuticalb
| 1 [1–4] | 2 [1–7] | <0.001 |
Median diameter of largest liver metastasis pretherapeutical (cm)b
| 3 [1.1–9.5] | 3 [1–10] | 0.454 |
Preoperative chemotherapy | <0.001 | ||
No | 74 (74 %) | 24 (34 %) | |
Yes | 26 (26 %) | 46 (66 %) | |
5FU | 6 (23 %) | 3 (7 %) | |
5FU + oxaliplatin | 14 (54 %) | 32 (70 %) | |
5FU + irinotecan | 6 (23 %) | 11 (24 %) | |
Antibody containing regimen | 0.043 | ||
Yes | 5 (19 %) | 20 (43 %) | |
No | 21 (81 %) | 26 (57 %) | |
Number of cycles | 5 [1.6–12.8] | 6 [2–23] | 0.675 |
More than one line | 1.000 | ||
Yes | 3 (12 %) | 5 (11 %) | |
No | 23 (88 %) | 41 (89 %) | |
Type of resectionc
| 0.061 | ||
Minor | 54 (54 %) | 27 (39 %) | |
Major | 46 (46 %) | 43 (61 %) | |
2-stage with PVO | |||
Yes | 3 | 20 | |
No | 97 | 50 | |
Morbidity rate | 28 (28 %) | 27 (39 %) | 0.183 |
Cardiopulmonary | 7 | 4 | |
Renal | 1 | 0 | 0.009 |
Bilioma | 4 | 10 | ┐ |
Liver insufficiencyd
| 3 | 5 | ┘ |
Wound healing disorder | 5 | 2 | |
Bleeding | 2 | 0 | |
Reoperation | 3 | 1 | |
Other | 3 | 5 | |
Mortality rate | 3 (3 %) | 1 (1 %) | 0.644 |
Number of liver metastases pathological | <0.001 | ||
1 | 73 (73 %) | 17 (24 %) | |
>1 | 27 (27 %) | 53 (76 %) | |
Median number of liver metastases pathologicalb
| 1 [1–6] | 2 [1–6.3] | <0.001 |
Median diameter of largest liver metastasis pathological (cm)b
| 3.3 [0.9–11.3] | 3.1 [0.7–10.7] | 0.493 |
Resection margin | 0.002 | ||
<1 cm | 53 (53 %) | 54 (77 %) | |
≥1 cm | 47 (47 %) | 16 (23 %) | |
mT stage [8] | <0.001 | ||
1 | 15 (15 %) | 2 (2 %) | |
2 | 65 (65 %) | 6 (9 %) | |
3 | 20 (20 %) | 1 (1 %) | |
4 | 0 (0 %) | 61 (87 %) | |
Fong score [10] | <0.001 | ||
0–2 | 48 (48 %) | 60 (86 %) | |
3–5 | 52 (52 %) | 10 (14 %) | |
Nordlinger score [16] | <0.001 | ||
0–2 | 42 (42 %) | 10 (14 %) | |
3–4 | 49 (49 %) | 50 (71 %) | |
5–6 | 9 (9 %) | 10 (14 %) | |
Adjuvant therapy | 0.275 | ||
No | 49 (49 %) | 28 (40 %) | |
Yes | 51 (51 %) | 42 (60 %) | |
Systemic chemotherapy | 25 | 11 | |
5FU | 2 (8 %) | 2 (18 %) | |
5FU + oxaliplatin | 13 (52 %) | 6 (55 %) | |
5FU + irinotecan | 10 (40 %) | 3 (27 %) | |
Antibody containing regimen | 0.645 | ||
Yes | 3 (12 %) | 2 (18 %) | |
No | 22 (88 %) | 9 (82 %) | |
Radioimmunotherapy | 26 | 31 | |
Number of cycles | |||
Systemic chemotherapy | 5 [2–12] | 3 [1.3–11.8] | 0.488 |
Radioimmunotherapy | 2 [1–2] | 1 [1–2] | 0.205 |
Surgical procedures
Histopathological workup
Postoperative treatment
Survival
Localization of second metastatic recurrence | Unilobar liver metastases N = 100 | Bilobar liver metastases N = 70 |
p value |
---|---|---|---|
All | 62 (100 %) | 49 (100 %) | 0.3273 |
Intrahepatic only | 24 (39 %) | 27 (55 %) | 0.1842 |
Intra- and extrahepatic | 6 (10 %) | 5 (10 %) | |
Extrahepatic only | 32 (52 %) | 17 (35 %) |