Abstract
BACKGROUND.
Hepatectomy is the standard of care for patients with colorectal cancer who have isolated hepatic metastases; however, the longโterm survival benefits of hepatectomy in this population have not been characterized well outside of case series. For the current study, a populationโbased database was used to compare the survival of patients with liver metastases from colorectal cancer who did and did not undergo hepatectomy.
METHODS.
Patients aged โฅ65 years with incident colorectal cancer who were diagnosed from 1991 to 2001 were identified from the linked Surveillance, Epidemiology, and End Results (SEER)โMedicare database. Liver metastasis diagnoses, colorectal resections, and hepatectomies were identified from hospital, outpatient, and physicianโsupplier claims. Patients who did not undergo colorectal resection were excluded. Fiveโyear survival from the time of cancer diagnosis was determined by the KaplanโMeier method. Cox proportional hazards models were used to evaluate survival.
RESULTS.
Among 13,599 patients who were identified with incident colorectal cancer and liver metastases, 7673 patients (56.4%) presented with stage IV disease, and the remaining patients presented with earlier stage disease and developed subsequent metastases. Only 833 patients (6.1%) in the cohort underwent hepatic resection, and their 30โday mortality rate was 4.3%. The 5โyear survival was 32.8% among patients who underwent hepatic resection, compared with 10.5% among patients who did not undergo hepatic resection (P < .0001), and better survival was observed in the subset of patients who presented initially with disease in stages I through III. In a Cox model, which was controlled for age, sex, race, comorbidities, and stage at presentation, lack of hepatic resection was associated with a 2.78โfold increased risk of death.
CONCLUSIONS.
Although hepatectomy rates among patients with colorectal cancer were low, hepatic resection was associated with improved survival. Cancer 2007 ยฉ 2007 American Cancer Society.