Researchers found that a higher number of recurrent liver metastatic sites, the presence of positive primary colorectal lymph nodes, and a shorter disease-free duration following first liver resection were risk factors for worse outcome in patients with metastatic colorectal cancer. The findings from this study were published in the Journal of Surgical Oncology.
Although liver resection offers the greatest likelihood of cure in patients with metastatic colorectal cancer confined to the liver, previous studies have shown that the risk of disease recurrence after surgery is high. While re-resection of recurrent disease remains an option for some patients, only limited data are available to guide treatment decisions in this setting.
The study involved long-term follow-up of 368 patients with metastatic colorectal cancer who underwent a first liver resection with curative intent while enrolled in a prospective clinical trial. At a median follow-up of 5 years, the overall survival (OS) rate for the overall population treated with first liver resection was 47%; median OS was 57 months and median disease-free survival was 17 months. Disease recurred in 264 (72%) of these patients, with most recurrences in the liver (51%) or lung (41%).
Within the population of patients with recurrent disease following first liver resection, the median OS of the subgroup of patients with more than 1 site of recurrent disease or disease-free duration less than 5 months and node-positive disease was 19 months compared with 36 months for the rest (ie, low-risk group) of the study population (hazard ratio [HR], 2.9; 95% CI, 2.2.-3.9). Furthermore, each risk factors was independently associated with decreased median OS in patients with disease recurrence following first liver surgery.
Following disease recurrence after first liver resection, 46% of patients were treated with chemotherapy only, 42% of patients underwent second resection involving liver (28%) and lung (46%), and 12% of patients received best supportive care only.
A second surgery for metastatic disease was associated with an improvement in OS compared with not undergoing re-resection of metastatic disease (HR, 0.32; 95% CI, 0.23‐0.44; P <.001).
However, a comparison of patients who did or did not undergo second resection for recurrent metastatic disease showed that those in the former subgroup were less likely to have node-positive primary colorectal cancer (65% versus 73%), had fewer sites of disease recurrence (1.1 versus 1.4), and a longer disease-free duration (19 versus 15 months) following first liver resection.
Recurrence of disease occurred in 72 patients (64%) undergoing a second re-section for metastatic disease, with lung (56%) and liver (43%) as the most common sites of disease recurrence.
Of the 72 patients with disease recurrence following second liver resection, 30 (42%) underwent a third curative-intent surgery, and disease recurred in 63%, with the lung being the most common site.
The study authors noted that re-resection of recurrent metastatic disease is “feasible, not only in the setting of liver‐limited disease, but also among patients with extrahepatic recurrence…”
They further commented that “the exact role of second, third, or even fourth surgical resection following recurrence is unknown, but it is possible that surgeons are choosing to resect patients in the low-risk group; therefore surgical resection may be a prognostic factor that is linked with, and dependent on, tumor biology.”
Serrano PE, Gu CS, Husien M, et al. Risk factors for survival following recurrence after first liver resection for colorectal cancer liver metastases [published online October 14, 2019]. J Surg Oncol. doi:10.1002/jso.25735
This article originally appeared on Oncology Nurse Advisor