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Annals of Surgical Oncology

, Volume 22, Issue 6, pp 1908–1914 | Cite as

Cure Model Survival Analysis After Hepatic Resection for Colorectal Liver Metastases

  • Alessando Cucchetti
  • Alessandro Ferrero
  • Matteo CesconEmail author
  • Matteo Donadon
  • Nadia Russolillo
  • Giorgio Ercolani
  • Giacomo Stacchini
  • Federico Mazzotti
  • Guido Torzilli
  • Antonio Daniele Pinna
Hepatobiliary Tumors

Abstract

Background

Statistical cure is achieved when a patient population has the same mortality as cancer-free individuals; however, data regarding the probability of cure after hepatectomy of colorectal liver metastases (CLM) have never been provided. We aimed to assess the probability of being statistically cured from CLM by hepatic resection.

Methods

Data from 1,012 consecutive patients undergoing curative resection for CLM (2001–2012) were used to fit a nonmixture cure model to compare mortality after surgery to that expected for the general population matched by sex and age.

Results

The 5- and 10-year disease-free survival was 18.9 and 15.8 %; the corresponding overall survival was 44.3 and 32.7 %. In the entire study population, the probability of being cured from CLM was 20 % (95 % confidence interval 16.5–23.5). After the first year, the mortality excess of resected patients, in comparison to the general population, starts to decline until it approaches zero 6 years after surgery. After 6.48 years, patients alive without tumor recurrence can be considered cured with 99 % certainty. Multivariate analysis showed that cure probabilities range from 40.9 % in patients with node-negative primary tumors and metachronous presentation of a single lesion <3 cm, to 1.5 % in patients with node positivity, and synchronous presentation of multiple, large CLMs. A model for the calculation of a cure fraction for each possible clinical scenario is provided.

Conclusions

Using a cure model, the present results indicate that statistical cure of CLM is possible after hepatectomy; providing this information can help clinicians give more precise answer to patients’ questions.

Keywords

Hepatic Resection Colorectal Liver Metastasis Future Remnant Liver Entire Study Population Future Remnant Liver Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work is dedicated to the memory of Prof. Lorenzo Capussotti.

Disclosure

The authors declare no conflict of interest.

Supplementary material

10434_2014_4234_MOESM1_ESM.doc (33 kb)
Supplementary material 1 (DOC 33 kb)

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Alessando Cucchetti
    • 1
  • Alessandro Ferrero
    • 2
  • Matteo Cescon
    • 1
    Email author
  • Matteo Donadon
    • 3
  • Nadia Russolillo
    • 2
  • Giorgio Ercolani
    • 1
  • Giacomo Stacchini
    • 1
  • Federico Mazzotti
    • 1
  • Guido Torzilli
    • 3
  • Antonio Daniele Pinna
    • 1
  1. 1.Department of Medical and Surgical Sciences, S. Orsola-Malpighi HospitalAlma Mater Studiorum - University of BolognaBolognaItaly
  2. 2.Department of General and Oncological SurgeryOspedale Mauriziano Umberto ITurinItaly
  3. 3.Department of Hepatobiliary Surgery, Humanitas Research HospitalSchool of Medicine - University of MilanMilanItaly

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