112P - Optimal classification and treatment strategy based on technical and oncological futures in recurrence of colorectal liver metastases

Background

Colorectal liver metastasis (CLM) is classified as Resectable, Unresectable, and Borderline resectable (BR) based on Technical and Oncological categories, with recommended treatments tailored to each classification. However, there is currently no appropriate classification for instances of liver recurrence in CLM (r-CLM).

Methods

This study evaluated patients with CLM who underwent initial liver resection between 2006 and 2020 and subsequently experienced liver recurrences. We investigated the long-term outcomes and prognostic factors related to r-CLM.

Results

Out of 949 cases of initial liver resection, 650 cases experienced recurrence, and among them, 392 cases were identified as r-CLM. Early recurrence within one year (er-CLM) exhibited significantly poorer overall survival (OS) compared to instances of r-CLM recurring after one year (p < 0.0001). Nonetheless, even within the er-CLM group, resected er-CLM showed notably improved prognosis in comparison to the non-resected group (5-year OS: 48.1% vs. 0%, p < 0.0001). Multivariate analysis of er-CLM identified independent prognostic factors as the number of recurrent tumors (≥ 4) (HR, 1.95; 95% CI, 1.24-3.07; p = 0.004), tumor size (≥ 5cm) (HR, 3.77; 95% CI, 1.46-9.76; p = 0.006), and presence of extrahepatic diseases (HR, 1.71; 95% CI, 1.09-2.71; p = 0.021). Stratifying these factors for recurrence-Resectable and recurrence-BR cases resulted in a significant difference in prognosis between the two groups (59.5% vs. 26.5%, p < 0.001).

Conclusions

Even in cases of early recurrence within one year, repeat liver resection contributes to extending prognosis. Regardless of the background at the initial liver resection, the number of r-CLM, tumor size, and presence of extrahepatic diseases were identified independent prognostic factors. Tailoring appropriate treatment based on the characteristics of recurrent tumors holds the potential to enhance the prognosis for r-CLM.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.