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Assessing the Impact of Primary Tumour Location on Survival After Resection of Colorectal Liver Metastases: A Propensity Weighted Retrospective Cohort Study

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Abstract

Background

Right-sided colonic tumours appear to have poorer survival after resection of colorectal liver metastases, although this may be confounded by various factors including advanced stage and emergency presentation.

Methods

Medical records of consecutive patients undergoing resection of colorectal liver metastases at a single centre from 2008 to 2015 were retrospectively reviewed. Cases were categorised by primary tumour location (right colon, left colon, rectum). Each primary location was weighted using propensity scores to balance covariates, including staging and mode of presentation. Cox regression was then applied to derive multivariable hazard ratios (HR) of survival after liver resection. Primary outcomes were 10-year overall survival (OS) and 5-year disease-free survival (DFS) after liver resection based on PTL.

Results

414 patients were included in the analysis. Left colonic tumours were significantly associated with higher rates of bilobar liver metastasis (36.2% vs. 20.1% and 30.1%) and larger maximum size of liver metastases compared with rectal and right-sided tumours, respectively. There was no difference in rates of extra-hepatic metastases, recurrence in the liver after resection or RAS, BRAF or p53 mutational status. After propensity weighting and Cox-regression, right-sided tumours were independently associated with significantly reduced 10 year OS (HR 1.56, 95% CI 1.03–2.36, p = 0.04) but not 5 year DFS (HR 1.36, 95% CI 0.89–2.08, p = 0.15).

Conclusions

Compared with left colonic and rectal tumours, right-sided colonic tumours are independently associated with inferior OS after resection of CRLM. This is despite higher rates of bilobar liver metastases and larger metastases with left-sided tumours.

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Data availability

Anonymised data are available on reasonable request from the corresponding author.

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Acknowledgements

We would like to thank Dr Rashid Mansoor of the University College London Department of Statistical Science for reviewing the statistical methods of this manuscript.

Funding

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Authors and Affiliations

  1. University Department of Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK

    Aditya Borakati, Farid Froghi, Alysha Shetye, Giuseppe K. Fusai, Brian R. Davidson & Reza Mirnezami

  2. Division of Surgery and Interventional Science, University College London, London, UK

    Aditya Borakati, Farid Froghi, Giuseppe K. Fusai & Brian R. Davidson

Authors
  1. Aditya Borakati
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  2. Farid Froghi
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Contributions

AB contributed to conceptualization, methodology, validation, formal analysis, investigation, writing—original draft, writing—review and editing, visualisation, project administration; FF contributed to conceptualization, writing—review and editing, supervision, project administration; AS contributed to investigation, validation; GKF contributed to conceptualization, writing—review and editing, supervision; BRD contributed to conceptualization, writing—review and editing, supervision; RM contributed to conceptualization, methodology, writing—review and editing, supervision, project administration.

Corresponding author

Correspondence to Reza Mirnezami.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was registered with the Royal Free Hospital’s Quality Governance Department as an audit. No formal research ethics committee review was required as it represents a retrospective study of health records with no alteration to patient care.

Statistical review

The statistical analysis in this study was reviewed by Dr Rashid Mansoor of the Department of Statistical Science at University College London.

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Supplementary file1 (DOCX 55 KB)

Appendix

Appendix

See Figs. 5, 6, 7 and 8.

Fig. 5
figure 5

Kaplan–Meier survival curves of variables and 10-year overall survival following liver resection for colorectal liver metastases; p-values calculated with log-rank test

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Fig. 6
figure 6

Kaplan–Meier survival curves of variables and 5-year disease-free survival following liver resection for colorectal liver metastases; p-values calculated with log-rank test

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Fig. 7
figure 7

Love plot of balance across imputations before and after propensity score weighting

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Fig. 8
figure 8

Plot of Schoenfeld residuals to test Cox proportional hazards assumption

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See Tables 5, 6, 7 and 8 .

Table 5 Distribution of liver metastases by primary tumour location; if a metastasis overlaps more than one liver segment, both segments are included; p-values calculated using Fisher’s exact test with Bonferroni’s correction
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Table 6 Balance across primary tumour location groups after multiple imputation and propensity score weighting for age, gender, staging, performance status, modified Charlson index and emergency presentation
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Table 7 Differences in patients with right-sided tumours by recurrence status after liver resection
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Table 8 Differences in patients with right-sided tumours grouped by survival
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Borakati, A., Froghi, F., Shetye, A. et al. Assessing the Impact of Primary Tumour Location on Survival After Resection of Colorectal Liver Metastases: A Propensity Weighted Retrospective Cohort Study. World J Surg 46, 1734–1755 (2022). https://doi.org/10.1007/s00268-022-06514-z

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  • DOI: https://doi.org/10.1007/s00268-022-06514-z

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