Annals of Surgical Oncology

, Volume 20, Issue 1, pp 148–154

Detailed Pathologic Characteristics of the Primary Colorectal Tumor Independently Predict Outcome after Hepatectomy for Metastases

  • Kenneth Cardona
  • Pedro Mastrodomenico
  • Francesco D’Amico
  • Jinru Shia
  • Mithat Gönen
  • Martin R. Weiser
  • Philip B. Paty
  • T. Peter Kingham
  • Peter J. Allen
  • Ronald P. De Matteo
  • Yuman Fong
  • William R. Jarnagin
  • Michael I. D’Angelica
Colorectal Cancer

DOI: 10.1245/s10434-012-2540-y

Cite this article as:
Cardona, K., Mastrodomenico, P., D’Amico, F. et al. Ann Surg Oncol (2013) 20: 148. doi:10.1245/s10434-012-2540-y

Abstract

Introduction

Outcome after hepatic resection for colorectal cancer liver metastases (CRLM) is heterogeneous and accurate predictors of survival are lacking. This study analyzes the prognostic relevance of pathologic details of the primary colorectal tumor in patients undergoing hepatic resection for CRLM.

Methods

Retrospective review of a prospective database identified patients who underwent resection for CRLM. Clinicopathological variables were investigated and their association with outcome was analyzed.

Results

From 1997–2007, 1,004 patients underwent hepatic resection for CRLM. The median follow-up was 59 months with a 5-year survival of 47 %. Univariate analysis identified nine factors associated with poor survival; three of these related to the primary tumor: lymphovascular invasion (LVI, p < 0.0001), perineural invasion (p = 0.005), and degree of regional lymph node involvement (N0 vs. N1 vs. N2, p < 0.0001). Multivariate analysis identified seven factors associated with poor survival, two of which related to the primary tumor: LVI (hazard ratio (HR) 1.3, 95 % confidence interval (CI) 1.06–1.64, p = 0.01) and degree of regional lymph node involvement [N1 (HR 1.3, 95 % CI 1.04–1.69, p = 0.02) vs. N2 (HR 1.7, 95 % CI 1.27–2.21, p < 0.0005)]. A significant decrease in survival along the spectrum of patients ranging from LVI negative/N0 to LVI positive/N2 was present. Patients who were LVI-positive/N2 had a median survival of 40 months compared with 74 months for patients who were LVI-negative/NO (p < 0.0001).

Conclusions

Histopathologic details of the primary colorectal tumor, particularly LVI and the detailed assessment of the degree of lymph node involvement, are strong predictors of survival. Future biomarker studies should consider exploring factors related to the primary colorectal tumor.

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Kenneth Cardona
    • 1
  • Pedro Mastrodomenico
    • 1
  • Francesco D’Amico
    • 1
  • Jinru Shia
    • 2
  • Mithat Gönen
    • 3
  • Martin R. Weiser
    • 4
  • Philip B. Paty
    • 4
  • T. Peter Kingham
    • 1
  • Peter J. Allen
    • 1
  • Ronald P. De Matteo
    • 1
  • Yuman Fong
    • 1
  • William R. Jarnagin
    • 1
  • Michael I. D’Angelica
    • 1
  1. 1.Department of Surgery, Division of Hepatopancreatobiliary SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Gastrointestinal Pathology Service, Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Epidemiology & Biostatistics, and Colorectal ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA