Analysis of Prognostic Factors Influencing Long-term Survival After Hepatic Resection for Metastatic Colorectal Cancer |
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Authors: | Marcella Arru Luca Aldrighetti Renato Castoldi Saverio Di Palo Elena Orsenigo Marco Stella Carlo Pulitanò Francesca Gavazzi Gianfranco Ferla Valerio Di Carlo Carlo Staudacher |
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Institution: | (1) Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy;(2) Liver Unit, Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy |
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Abstract: | Background The aim of this study was to analyze the prognostic factors associated with long-term outcome after liver resection for colorectal
metastases. The retrospective analysis included 297 liver resections for colorectal metastases.
Methods The variables considered included disease stage, differentiation grade, site and nodal metastasis of the primary tumor, number
and diameter of the lesions, time from primary cancer to metastasis, preoperative carcinoembryonic antigen (CEA) level, adjuvant
chemotherapy, type of resection, intraoperative ultrasonography and portal clamping use, blood loss, transfusions, complications,
hospitalization, surgical margins status, and a clinical risk score (MSKCC-CRS).
Results The univariate analysis revealed a significant difference (p < 0.05) in overall 5-year survival rates depending on the differentiation grade, preoperative CEA >5 and >200 ng/ml, diameter
of the lesion >5 cm, time from primary tumor to metastases >12 months, MSKCC-CRS >2. The multivariate analysis showed three
independent negative prognostic factors: G3 or G4 grade, CEA >5 ng/ml, and high MSKCC-CRS.
Conclusions No single prognostic factor proved to be associated with a sufficiently disappointing outcome to exclude patients from liver
resection. However, in the presence of some prognostic factors (G3–G4 differentiation, preoperative CEA >5 ng/ml, high MSKCC-CRS),
enrollment of patients in trials exploring new adjuvant treatments is suggested to improve the outcome after surgery. |
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