Surgical strategy for colorectal cancer with synchronous liver and extrahepatic metastases: A scoring system and decision tree model

Chan Wei Tseng, Hao Wei Teng, Chun Chi Lin, Hao Jan Lei*, Jung Jyh Hung, Wen Yih Liang, Cheng Yuan Hsia, Shu Cheng Chou, Hung Hsin Lin, Sheng Chieh Huang, Hou Hsuan Cheng, Yuan Tzu Lan, Huann Sheng Wang, Shung Haur Yang, Wei Shone Chen, Jen Kou Lin, Jeng Kai Jiang, Shih Ching Chang, Gar Yang Chau

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The role of hepatectomy in a specific group of patients with synchronous colorectal cancer with liver metastases (SCRLM) and synchronous extrahepatic disease (SEHD) is still unclear. The aim of this study was to evaluate the efficacy of liver surgery and define the selection criteria for surgical candidates in patients with SCRLM + SEHD. Methods: Between July 2007 and October 2018, 475 patients with colorectal cancer with liver metastases (CRLM) who underwent liver resection were retrospectively reviewed. Sixty-five patients with SCRLM + SEHD were identified and included in the study. Clinical pathological data of these patients were analyzed to evaluate the influence on survival. Important prognostic factors were identified by univariate and multivariate analyses. The risk score system and decision tree analysis were generated according to the important prognostic factors for better patient selection. Results: The 5-year survival rate of patients with SCRLM + SEHD was 21.9%. The most important prognostic factors were SCRLM number of more than five, site of SEHD other than the lung only, inability to achieve SCRLM + SEHD R0 resection, and BRAF mutation of cancer cells. The proposed risk score system and decision tree model easily discriminated between patients with different survival rates and identified the profile of suitable surgical patients. Conclusion: Liver surgery should not be a contraindication for patients with SCRLM + SEHD. Patients with complete SCRLM + SEHD R0 resection, SCRLM number less than or equal to five, SEHD confined to the lung only, and wild-type BRAF could have favorable survival outcomes. The proposed scoring system and decision tree model may be beneficial to patient selection in clinical use.

Original languageEnglish
Pages (from-to)732-739
Number of pages8
JournalJournal of the Chinese Medical Association
Volume86
Issue number8
DOIs
StatePublished - 1 Aug 2023

Keywords

  • Colorectal cancer with liver metastases
  • Extrahepatic metastases
  • Liver resection
  • Scoring system
  • Synchronous metastases

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