Aim: To assess the effect of the factor ‘hepatic metastatic disease’ on long-term outcomes in patients with colorectal cancer.
Materials and methods: We analysed retrospectively 200 randomly selected patients. Forty-two of them were excluded from the study for different reasons so the study contingent was 158 patients over a period of 23 years. All were diagnosed and treated in the Lozenetz University Hospital, in the Department of General Surgery. 125 of the patients were diagnosed with colorectal cancer without distant metastases and 33 of the patients had liver metastases as a result of colorectal carcinoma. The statistical analysis was performed using SPSS 19 IMB, with a level of significance of P < 0.05 at which the null hypothesis is rejected. We also used descriptive analysis, Kaplan-Meier estimator, Log-Rank Test and Life-Table statistics models.
Results: The median survival for patients without metastases was 160 months, and the median was 102 months. The median survival for patients with liver metastases was 28 months and the median was 21 months. One-year survival for patients without metastases was 92% versus 69% in patients with liver metastases. Conclusion: Average, annual and median survivals are influenced statistically significantly by the presence of liver metastases compared to overall survival and that of patients without metastatic colorectal cancer. Liver metastatic disease is a proven factor affecting long-term prognosis and survival in patients with colorectal cancer.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Duraker Н, Çaynak Z, Hot S. The impact of primary tumor resection on overall survival in patients with colorectal carcinoma and unresectable distant metastases: A prospective cohort study. International Journal of Surgery 2014;12(7):737-41.
2. Dimitrova N. Colon (C18,ICD10) In: Dimitrova N, Vukov M, Valerianova Z. Cancer incidence in Bulgaria 2011. Volume XXII. Paradigma”2013”;2013:56.
3. Mantke R, Schmidt U, Wolff S, et al. Incidence of synchronous liver metastases in patients with colorectal cancer in relationship to clinicopathologic characteristics. Results of a German prospective multicentre observational study. European Journal of surgical oncology 2012;38(3):259-65.
4. Lee J, Jeon J, Maverhardt J. Diet and Lifestyle in Survivors of Colorectal Cancer. Hematology/Oncology Clinics of North America 2015;29(1):1-27.
5. Velde CJH, Boelens PG, Tains PJ, et al. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, options and experiences from the experts of surgery. EJSO 2014;40(4):454-68.
6. Thosani N, Guha S, Singh H. Colonoscopy and Colorectal Cancer Incidence and Mortality. Gastroenterology Clinics of North America 2013;42(3): 619-37.
7. Hao CY, Ji JF. Surgical treatment of liver metastases of colorectal cancer: Strategies and controversies in 2006. EJSO 2006;32(5):473-83
8. Strang A, Fischbach R, Teichmann W, et al. A systematic review on clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. EJC 2009;45(10):1748-56.
9. Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist 2008;12:51-64.
10. Slotta JE, Schuld J, Distler S, Richter S, Schilling MK, Kollmar O. Hepatic resection of non-colorectal and non-neuroendocrine liver metastases - survival benefit for patients with non-gastrointestinal primary cancers - a case-controlled study. Int J Surg 2014;12(2):163-8.
11. Albercht MH, Wichmann JL, Muller C, et al. Assessment of colorectal liver metastases using MRI and CT: Impact of observer experience on diagnostic performance and interobserver reproducibility with histopathological correlation. Eur J Radiol 2014;83(10):1752-8.
12. Jones RP, Hamann S, Malik HZ, Fenwick SW, et al. Defined criteria for resectability improves rates of secondary resection after systemic therapy for liver limited metastatic colorectal cancer. Eur J Cancer 2014;50(9):1590-1601.
13. Ghazali AK, Musa KI, Naing NN, et al. Prognostic Factors in Patients With Colorectal Cancer at Hospital University Sains Malaysia. Asian J Surg 2010;33(3):127-33.
14. Ferrand F, Malka D, Bourredjem A, et al. Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy: Results from the multi-center, randomised trial Fédération Francophone de Cancérologie Digestive 9601. Eur J Cancer 2013;49(1):90-7.
15. Kelsall HL, Baglietto L, Muller D, et al. The effect of socioeconomic status on survival from colorectal cancer in the Melbourne Collaborative Cohort Study. Social Science & Medicine 2000;68(2):290-7.
16. Tong L, Ahn C, Symanskit E, et al. Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer: A US database study among elderly patients. Cancer Epidemiology 2014;38(6):733-40.
17. Benavides M, Pericay C, Auerbes MV, et al. Oxaliplatin in Combination With Infusional 5-Fluorouracil as First-Line Chemotherapy for Elderly Patients With Metastatic Colorectal Cancer: A Phase II Study of the Spanish Cooperative Group for the Treatment of Digestive Tumors. Clinical Colorectal Cancer 2012;11(3):200-6.
18. Munoz P, Urien MA, Ravina AR. Efficacy and safety of intraoperative radiotherapy in colorectal cancer: A systematic review. Cancer Letters 2011;306(2): 121-33.
19. Kumar R, Price TJ, Beeke C, et al. Colorectal cancer Survival: An analysis of Patients With Metastatic Disease Synchronous and Metachronous With the Primary Tumor. Clinical Colorectal Cancer 2014;13(2):87-93.
20. Lordan JT, Karanjia ND, Quiney N, et al. A 10-year study of outcome following hepatic resection for colorectal liver metastases – the effect of evaluation in a multidisciplinary team setting. EJSO 2009;35(3):302-6.
21. Khattak M, Martin HL, Beeke C, et al. Survival Differences in Patients With Metastatic Colorectal Cancer and With Single Site Metastatic Disease at Initial Presentation: Results From South Australian Clinical Registry for Advanced Colorectal Cancer. Clinical Colorectal Cancer 2012;11(4):247-54.
22. Kishiki T, Masaki T, Matsuoka H, et al. Modified Glasgow prognostic score in patients with incurable stage IV colorectal cancer. The American Journal of Surgery 2013;206(2):234-40.
23. Nordlinger B, Custem EV, Rougier P, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group. European Journal of Cancer 2007;43(14):2037-45.
24. Erning FN, Steenbergen LN, Lemmens VEPP, et al. Conditional Survival for long-term colorectal cancer survivors in the Netherlands: who do best? EJC 2014;50(10):1732-9.
25. Leblanc F, Fonck M, Brunet R, et al. Comparison of hepatic recurrences after resection or intraoperative radiofrequency ablation indicated by size and topographical characteristics of the metastases. European Journal of Surgical Oncology (EJSO) 2008;34(2):185-90.
26. Langenhoff BS, Krabbe PF, Ruers TJ. Efficacy of follow-up after surgical treatment of colorectal liver metastases. European Journal of Surgical Oncology (EJSO) 2009;35(2):180-6.
27. Maslyankov S, Penchev D, Fidoshev I. Correlation between serum levels and pathologic stages of tumor markers used in colorectal carcinoma. Journal MD 2014;4 (82):79-82 (Bulgarian).
28. Wallace K, Streba KR, Gore E, et al. Prognostic Factors in Relation to Racial Disparity in Advanced Colorectal Cancer Survival. Clinical Colorectal Cancer 2013;12(4):287-93.
29. Duduv A, Koleva M. Follow-up in colorectal cancer - evidence based medicine. Kalev D. Uchebna Kniga 2011, Clinical behavior in colorectal and anal cancer. MOPE 2011:37-8 (Bulgarian).