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Prediction of Recurrence Patterns from Hepatic Parenchymal Disease After Resection of Colorectal Liver Metastases

Annals of Surgical Oncology volume 27, pages 188–195 (2020)Cite this article

Abstract

Background

Obesity and metabolic syndrome are associated with inflammatory hepatic parenchymal disease (HPD) and increased risk for recurrence after resection of colorectal liver metastases (CRLM). The independent impact of HPD on recurrence patterns has not been well defined.

Methods

The nonalcoholic fatty liver disease activity score (NAS) was used to quantify HPD including steatosis and fibrosis for all patients with completely resected CRLM between April 2003 and March 2007. Clinicopathologic factors, perioperative history, and outcomes were compared with the NAS. Fisher’s exact test was used to examine the association between severe HPD (NAS ≥ 3) with clinical and perioperative characteristics. Kaplan–Meier methods were used to estimate recurrence-free survival (RFS). The cumulative incidences of recurrence [any intrahepatic recurrence (IHR), extrahepatic recurrence only (EHR), and death without recurrence (DWR)] were estimated using competing risks methods.

Results

Among the 357 patients included in this study, microsteatosis was noted in 124 (35%) patients, severe HPD in 31 (9%), steatohepatitis in 14 (4%), and sinusoidal injury in 36 (10%). After median follow-up of 127 months (range 4–175 months), 10-year RFS was 22% [95% confidence interval (CI) 17–27%]. Ten-year cumulative incidence for IHR, EHR, and DWR was 37%, 30%, and 12%, respectively. After controlling for confounders, NAS ≥ 3 was independently associated with higher risk of IHR [hazard ratio (HR) 1.76, 95% CI 1.07–2.90, p = 0.027] and lower risk of EHR (HR 0.18, 95% CI 0.04–0.75, p = 0.019) on multivariable analysis.

Conclusions

Severe HPD was associated with increased IHR risk and decreased EHR risk. Future investigation into whether improving HPD from reversible etiologies can reduce the risk for IHR is warranted.

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Funding

This work was supported in part by the NIH/NCI P30 CA008748 Cancer Center Support Grant.

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Authors and Affiliations

  1. Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Raja R. Narayan MD, MPH, Jennifer W. Harris MD, PhD, Peter J. Allen MD, Vinod P. Balachandran MD, Jeffrey A. Drebin MD, PhD, William R. Jarnagin MD, T. Peter Kingham MD & Michael I. D’Angelica MD

  2. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Raja R. Narayan MD, MPH

  3. Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Joanne F. Chou MPH & Mithat Gönen PhD

  4. Department of Pathology, Scripps Clinic, La Jolla, CA, USA

    Fei Bao MD

  5. Department of Pathology, Gastrointestinal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jinru Shia MD

  6. Department of Medicine, Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Nancy E. Kemeny MD

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  1. Raja R. Narayan MD, MPH
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Correspondence to Michael I. D’Angelica MD.

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Narayan, R.R., Harris, J.W., Chou, J.F. et al. Prediction of Recurrence Patterns from Hepatic Parenchymal Disease After Resection of Colorectal Liver Metastases. Ann Surg Oncol 27, 188–195 (2020). https://doi.org/10.1245/s10434-019-07934-3

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  • DOI: https://doi.org/10.1245/s10434-019-07934-3