Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2020; 12(10): 1177-1194
Published online Oct 15, 2020. doi: 10.4251/wjgo.v12.i10.1177
Prognostic factors and therapeutic effects of different treatment modalities for colorectal cancer liver metastases
Zuo-Hong Ma, Yong-Peng Wang, Wen-Heng Zheng, Ji Ma, Xue Bai, Yong Zhang, Yuan-He Wang, Da Chi, Xi-Bo Fu, Xiang-Dong Hua
Zuo-Hong Ma, Yong-Peng Wang, Xue Bai, Yuan-He Wang, Da Chi, Xi-Bo Fu, Xiang-Dong Hua, Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
Wen-Heng Zheng, Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
Ji Ma, Yong Zhang, Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
Author contributions: Ma ZH and Hua XD conceived this study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects; Wang YP, Zheng WH, Zhang Y, and Bai X improved the study design and contributed to the interpretation of results; Chi D and Fu XB performed data processing and statistical analysis; Ma ZH wrote the manuscript; Ma J and Wang YH revised the manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute (Approval No. 20200102).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiang-Dong Hua, MD, Chief Doctor, Surgeon, Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Shenyang 110042, Liaoning Province, China. lnzl_hxd@163.com
Received: July 20, 2020
Peer-review started: July 20, 2020
First decision: August 9, 2020
Revised: August 18, 2020
Accepted: September 14, 2020
Article in press: September 14, 2020
Published online: October 15, 2020
Abstract
BACKGROUND

Colorectal cancer (CRC) is one of the most common malignant tumors in China, and the liver is the most common metastatic site in patients with advanced CRC. Hepatectomy is the gold standard treatment for colorectal liver metastases. For patients who cannot undergo radical resection of liver metastases for various reasons, ablation therapy, interventional therapy, and systemic chemotherapy can be used to improve their quality of life and prolong their survival time.

AIM

To explore the prognostic factors and treatments of liver metastases of CRC.

METHODS

A retrospective analysis was conducted on 87 patients with liver metastases from CRC treated at the Liaoning Cancer Hospital and Institute between January 2005 and March 2011. According to different treatments, the patients were divided into the following four groups: Surgical resection group (36 patients); ablation group (23 patients); intervention group (15 patients); and drug group (13 patients). The clinicopathological data and postoperative survival of the four groups were analyzed. The Kaplan-Meier method was used for survival analysis, and the Cox proportional hazards regression model was used for multivariate analysis.

RESULTS

The median survival time of the 87 patients was 38.747 ± 3.062 mo, and the 1- and 3-year survival rates were 87.5% and 53.1%, respectively. The Cox proportional hazards model showed that the following factors were independent factors affecting prognosis: The degree of tumor differentiation, the number of metastases, the size of metastases, and whether the metastases are close to great vessels. The results of treatment factor analysis showed that the effect of surgical treatment was better than that of drugs, intervention, or ablation alone, and the median survival time was 48.83 ± 4.36 mo. The drug group had the worst prognosis, with a median survival time of only 13.5 ± 0.7 mo (P < 0.05). For patients with liver metastases of CRC near the great vessels, the median survival time (27.3 mo) of patients undergoing surgical resection was better than that of patients using other treatments (20.6 mo) (P < 0.05).

CONCLUSION

Patients with a low degree of primary tumor differentiation, multiple liver metastases (number of tumors > 4), and maximum diameter of liver metastases > 5 cm have a poor prognosis. Among drug therapy, intervention, ablation, and surgical treatment options, surgical treatment is the first choice for liver metastases. When liver metastases are close to great vessels, surgical treatment is significantly better than drug therapy, intervention, and ablation alone.

Keywords: Colorectal cancer, Liver metastasis, Prognostic factors, Ablation, Surgical resection, Retrospective study

Core Tip: Pathological data of patients with liver metastases from colorectal cancer were analyzed and the diameter, differentiation, and multiple lesions of liver metastases, were found to indicate a poor prognosis. The analysis of different treatment methods for patients with liver metastases from colorectal cancer proved that radical surgery is always the best option. For inoperable patients, personalized combination therapy is actively recommended.