Curatively Intended Treatment of Colorectal Liver Metastases - Patient, Primary and Metastatic Pattern as Prognostic Factors

Abstract

Background: Resection and/or ablation of colorectal liver metastases (CRLM) is increasingly common and long-term results are improving. In this thesis prognosis of CRLM is studied in a wide perspective, with focus on common clinical factors to consider in preoperative decision making.

Study I-III: Data on radically resected colorectal cancer (CRC) was col-lected from the Swedish Colorectal Cancer Registry (SCRCR) and patients also treated for CRLM were identified in the Swedish Registry for Liver Cancer (Sweliv). A total of 1325 patients were treated for CRLM with a 5-year relative survival (RS) >50%, also for patients ≥75 years of age. Com-plications from the primary tumor resection and primary tumor characteris-tics had a large impact on long-term survival after treatment of CRLM. Liver metastasis >20 mm, was associated with increased risk. Number of tumors was of less importance when tumor location was considered. Abla-tion doubled the risk of death within 5 years in a propensity score analysis. Postoperative complications (POC) were registered for 24% of all patients and were associated with inferior 5-year RS and prolonged hospital stay. Laparoscopic technique lowered the risk for POC.

Study IV-V: The study cohort was based on the randomized COLOFOL trial and included patients with recurrent disease after radically resected CRC. All recurrences within 5 years postoperatively were identified and medical files were scrutinized. Out of 2442 patients, 471 developed any kind of local recurrences or metachronous metastases of which 48% were treated with curative intent. Over 90% of the 235 patients with CRLM were assessed in multidisciplinary tumor boards, 123 (52%) were treated with curative intent with subsequent 5-year overall survival (OS) of 58%. High frequency follow-up after primary tumor resection was a positive prognostic factor for patients with CRLM.

Conclusion: Prognosis of CRLM depend on patient, primary tumor, met-astatic pattern, and choice of treatment. After multidisciplinary assessment, high resection rates and long-term survival are achievable.