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Erschienen in:
01.12.2010 | Healthcare Policy and Outcomes
Patterns of Referral and Resection Among Patients with Liver-Only Metastatic Colorectal Cancer (MCRC)
Erschienen in: Annals of Surgical Oncology | Ausgabe 12/2010
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Background
Rates of metastatectomy vary among patients with liver-only metastatic colorectal cancer (MCRC). This study describe predictors of referral to a hepatobiliary surgeon (HBS) and hepatic resection in a population-based setting.
Materials and Methods
Patients referred to the British Columbia Cancer Agency (BCCA) with synchronous or relapsed MCRC isolated to the liver in 2002–2004 were identified. Classification of tumor burden as “high” or “low” was based on prognostic features defined by LiverMetSurvery registry. Metastases larger than 5 cm, bilobar, or more than 3 metastases were classified as high tumor burden. Multivariate logistic regression models were used to identify predictors of HBS referral and subsequent metastatectomy. Overall survival was calculated by the Kaplan–Meier method.
Results
Of 618 patients with isolated hepatic metastasis, 148 (24%) were referred to a HBS and 99 (16%) underwent resection. Advanced age was the most common reason for not referring 64 patients (10%) with ECOG performance status 0/1 and low tumor burden. In multivariate analysis, variables associated with referral were younger age (P < .001), ECOG performance status 0/1 (P < .002), chemotherapy for metastatic disease (P = .007), 1–3 metastasis (P < .001), and unilobar disease (P < .001). Median patient survival was 0.99 years (95% confidence interval [95% CI], 0.89–1.10 years) among nonreferred, 1.83 years (95% CI, 1.37–2.31 years) if referred but not resected, and 3.85 years (95% CI, 2.90–4.80 years) if resected.
Conclusion
A significant proportion of patients are not referred to a HBS because of advanced chronological age. Resection of hepatic metastases was associated with improved overall survival irrespective of initial tumor burden.