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Prognostic role of infracentimetric colorectal liver metastases

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Abstract

Background

The number of lesions and the size of the largest (CRLMmax) have been widely investigated as prognostic factors in patients with colorectal liver metastases (CRLM). The aim of the present study was to assess whether, in patients undergoing curative liver resection, the presence of infracentimetric lesions could affect recurrence-free survival (RFS) and overall survival (OS).

Methods

Patients who underwent a liver resection for CRLM between 2001 and 2019 were included. The size of CRLM was measured on the surgical specimen. The best cut-off of the smallest lesion (CRLMmin) associated with RFS was determined through the time-dependent ROC analysis. A multivariate Cox regression analysis was carried out.

Results

Overall, 227 patients were included. Median follow-up time was 50 months [IQR 26–84]. Recurrence occurred for 151 (66.5%) patients (liver recurrence in 67.5%, while exclusive extra-hepatic recurrence in 32.5%). The best cut-off for CRLMmin associated with RFS was 9 mm, with 12- and 24-month td-AUC 0.56 and 0.52 respectively. CRLMmin ≤ 9 mm was found to be an independent prognostic factor that impairs RFS at multivariate analysis (HR 1.534 (1.02–2.32), p = 0.042). In particular, CRLMmin ≤ 9 mm was correlated with impaired hepatic RFS (HR 1.860 (1.15–3.01), p = 0.011), but not extra-hepatic RFS.

Conclusions

Infracentimetric metastases (≤ 9 mm) are an independent prognostic factor that impairs hepatic RFS. This result suggests the potential benefit of neoadjuvant chemotherapy (CT) also in selected patients with initially resectable lesions, in case of CRLM ≤ 9 mm on preoperative imaging.

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Data Availability

Data available on request from the authors.

Abbreviations

CRLM:

Colorectal liver metastases

CRLMmax:

Largest colorectal liver metastasis

CRLMmin:

Smallest colorectal liver metastasis

RFS:

Recurrence-free survival

OS:

Overall survival

ROC:

Receiving operating curve

FLR:

Future liver remnant

CT-scan:

Computed tomography

MR:

Magnetic resonance

US:

Ultrasound

CT:

Chemotherapy

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Author information

Authors and Affiliations

  1. Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France

    Fabio Frosio, Alexandra Nassar, Nicole Faermark, Yves Sanou, Stephane Bonnet, Brice Gayet & David Fuks

  2. Department of Oncology, Institut Mutualiste Montsouris, Paris, France

    Baptiste Cervantes & Christophe Louvet

  3. Department of Pathology, Institut Mutualiste Montsouris, Paris, France

    Marine Lefevre

Authors
  1. Fabio Frosio
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  2. Baptiste Cervantes
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  3. Alexandra Nassar
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  4. Nicole Faermark
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  5. Yves Sanou
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  6. Stephane Bonnet
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  7. Marine Lefevre
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  8. Christophe Louvet
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  9. Brice Gayet
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  10. David Fuks
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Contributions

All authors contributed to the study conception and design. In particular, material preparation, data collection and analysis were performed by Fabio Frosio and Baptiste Cervantes. The first draft of the manuscript was written by Fabio Frosio and all authors commented on previous versions of the manuscript. Christophe Louvet, Brice Gayet and David Fuks revised it critically. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fabio Frosio.

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Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Frosio, F., Cervantes, B., Nassar, A. et al. Prognostic role of infracentimetric colorectal liver metastases. Langenbecks Arch Surg 407, 1971–1980 (2022). https://doi.org/10.1007/s00423-022-02499-4

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  • DOI: https://doi.org/10.1007/s00423-022-02499-4

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