Indicators for treatment strategies of colorectal liver metastases.

OBJECTIVE To analyze the survival predictors of patients undergoing hepatectomy for colorectal liver metastasis to determine useful indicators for therapy selection. SUMMARY BACKGROUND DATA Although recurrence develops in more than two thirds of patients undergoing hepatectomy for colorectal liver metastasis, preoperative characteristics that might predict such recurrence have yet to be clearly identified. METHODS Clinicopathologic data of 85 consecutive patients with colorectal cancer who underwent a curative resection of primary lesions and metastatic liver diseases at one institute were analyzed using the multivariate method with respect to both the metastatic state and the primary lesion. RESULTS Multivariate analysis indicated that the aggressiveness of the primary tumor, early liver metastasis, and a large number of liver metastases were the characteristics that could be detected before hepatectomy and that independently indicated a worse survival. A three-ranked classification based on these coefficients (H-staging) was significantly related to both the recurrence rate within 6 months (7% in H-stage A, 30% in B, and 44% in C) and the 5-year survival rates (55%, 14%, and 0% respectively). An additional scoring system (H'-staging) based on the aggressiveness of the primary tumor and the level of carcinoembryonic antigen 1 to 3 months after hepatectomy was found to be related to the mode of subsequent recurrence and surgical resectability of the recurrent foci. CONCLUSIONS H-staging can provide useful prognostic information for the treatment of liver metastasis. H-staging could also help in predicting the possible mode of recurrence after hepatectomy and in determining the most suitable mode of additional therapy. Further multiinstitutional studies based on a large collective database will confirm the utility of these two staging systems.