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.
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.
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).
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
All authors have declared no conflicts of interest.