155P - Early recurrence after hepatectomy for colorectal liver metastases: the definition and predictive factors

Date 19 December 2015
Event ESMO Asia 2015 Congress
Session Poster presentation 1
Topics Colon Cancer
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Katsunori Imai
Citation Annals of Oncology (2015) 26 (suppl_9): 42-70. 10.1093/annonc/mdv523
Authors K. Imai1, M. Allard1, C. Castro Benitez1, E. Vibert1, A. Sa Cunha1, D. Cherqui1, D. Castaing1, H. Bismuth1, T. Beppu2, H. Baba2, R. Adam1
  • 1Centre Hépato-biliaire, Hopital Paul Brousse, F-94804 - Villejuif/FR
  • 2Department Of Gastroenterological Surgery, Kumamoto University, 860-8556 - Kumamoto/JP

Abstract

Aim/Background

Although early recurrence is one of the prognostic factors of poor survival after surgery for colorectal liver metastases (CRLM), the definition of early recurrence has been determined arbitrarily. The aim of this study was to determine the optimal cut-off point of early recurrence and elucidate its predictive factors after hepatectomy for CRLM.

Methods

From a total cohort of 987 patients who underwent curative hepatectomy for CRLM between 1990 and 2012, 846 patients who had a minimum follow-up period of 24 months were eligible for this study. Minimum P value approach of survival after initial recurrence was used to determine the optimal cut-off points for the definition of early recurrence. Predictive factors of early recurrence and prognostic factors of survival in patients with early and late recurrence were analyzed.

Results

The 5-year overall and disease-free survival rate were 50.2 and 17.8%, respectively. For 667 patients (79%) who developed recurrence, the optimal cut-off point of early recurrence was determined to be 8 months after hepatectomy. The impact of early recurrence on survival was demonstrated mainly in patients who received preoperative chemotherapy. Among the 691 patients who received preoperative chemotherapy, recurrence was observed in 562 patients (81%), and the survival in patients with early recurrence was significantly worse than that with late recurrence (5-year survival: 18.5% vs. 53.4%, P < 0.0001). Multivariate logistic analysis identified age ≤ 57 (relative risk (RR) 1.79, P = 0.0022), preoperative chemotherapy lines > 1 (RR 1.58, P = 0.03), disease progression during last-line chemotherapy (RR 2.18, P = 0.024), tumor number > 3 (RR 1.81, P = 0.0014), and carbohydrate antigen 19-9 > 60 U/mL (RR 2.21, P = 0.0003) as independent predictive factors of early recurrence. Salvage surgery for recurrence improved survival significantly, even in patients with early recurrence (5-year survival: 38.8% vs. 4.2%, P < 0.0001).

Conclusions

For better selection of patients who could really benefit from surgery, preoperative prediction of early recurrence is crucial. Salvage surgery should be taken into account proactively even for early recurrence.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.