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



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.


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.


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.


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.


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.



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


The authors declare no conflict of interest.

Supplementary material

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


  1. 1.
    Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMedGoogle Scholar
  2. 2.
    US Cancer Statistics Working Group. United States cancer statistics: 1999–2010 incidence and mortality Web-based report. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013. Available at: Accessed 1 Feb 2014.
  3. 3.
    Garden OJ, Rees M, Poston GJ, et al. Guidelines for resection of colorectal cancer liver metastases. Gut. 2006;55(Suppl 3):iii1–8.Google Scholar
  4. 4.
    Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Pulitanò C, Castillo F, Aldrighetti L, et al. What defines “cure” after liver resection for colorectal metastases? Results after 10 years of follow-up. HPB (Oxford). 2010;12:244–9.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Statistical Methodology and Applications Branch, Data Modeling Branch, National Cancer Institute. Cansurv, version 1.1. Available at: Accessed 1 Feb 2014.
  7. 7.
    Othus M, Barlogie B, Leblanc ML, et al. Cure models as a useful statistical tool for analyzing survival. Clin Cancer Res. 2012;18:3731–6.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Lambert PC, Thompson JR, Weston CL, et al. Estimating and modeling the cure fraction in population-based cancer survival analysis. Biostatistics. 2007;8:576–94.CrossRefPubMedGoogle Scholar
  9. 9.
    Terminology Committee of the IHPBA. The Brisbane 2000 terminology of liver anatomy and resections. Abingdon: Taylor & Francis; 2000. p. 333–9.Google Scholar
  10. 10.
    Smoll NR, Schaller K, Gautschi OP. The cure fraction of glioblastoma multiforme. Neuroepidemiology. 2012;39:63–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Fuller AF, Griffiths CT. Gynecologic oncology. Amsterdam: Wolters Kluwer; 1983.Google Scholar
  12. 12.
    Lambert PC. Modeling of the cure fraction in survival studies. Stata J. 2007;3:1–25.Google Scholar
  13. 13.
    Tsodikov AD, Ibrahim JG, Yakovlev AY. Estimating cure rates from survival data: an alternative to two-component mixture models. J Am Stat Assoc. 2003;98:1063–78.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Italian population life tables. Available at: Accessed 1 Dec 2013.
  15. 15.
    Adam R, Bismuth H, Castaing D, et al. Repeat hepatectomy for colorectal liver metastases. Ann Surg. 1997;225:51–60.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Adam R, De Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–39.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Cvancarova M, Aagnes B, Fosså SD, et al. Proportion cured models applied to 23 cancer sites in Norway. Int J Cancer. 2013;132:1700–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Dal Maso L, Guzzinati S, Buzzoni C, et al. Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818,902 Italian patients and 26 cancer types. Ann Oncol. 2014;25:2251-60.Google Scholar
  19. 19.
    Viganò L, Capussotti L, Lapointe R, et al. Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6,025 patients. Ann Surg Oncol. 2014;21(4):1276–1286.Google Scholar
  20. 20.
    Tai P, Yu E, Cserni G, et al. Minimum follow-up time required for the estimation of statistical cure of cancer patients: verification using data from 42 cancer sites in the SEER database. BMC Cancer. 2005;5:48.CrossRefPubMedCentralPubMedGoogle Scholar

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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