Predictors of surgical non-referral for colorectal liver metastases

被引:7
作者
Ahmad, Ali [1 ,2 ]
Reha, Jeffrey [1 ,2 ]
Somasundar, Ponnandai [1 ,2 ]
Espat, N. Joseph [1 ,2 ]
Katz, Steven C. [1 ,2 ]
机构
[1] Roger Williams Med Ctr, Dept Surg, Providence, RI USA
[2] Boston Univ, Sch Med, Dept Surg, Boston, MA 02118 USA
关键词
Colorectal cancer; Colorectal liver metastases; Surgical referral; Survival; Multidisciplinary care; HEPATIC RESECTION; IMPROVED SURVIVAL; CLINICAL SCORE; PHASE-3; TRIAL; CANCER; CHEMOTHERAPY; SURGERY; GUIDELINES; CETUXIMAB; OUTCOMES;
D O I
10.1016/j.jss.2016.06.037
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Surgical resection is the only curative option for patients with colorectal liver metastases (CRLM). The objective of our study was to identify factors associated with failure to refer patients with CRLM to a surgeon with oncologic and hepatobiliary expertise. Materials and methods: Data were retrospectively reviewed on 75 patients with CRLM treated at our institution. Patients were divided into referred and nonreferred groups for comparison. Quantitative assessment of association was tabulated using the odds ratio (OR). Statistical comparison was performed using the chi-square test and multiple regression models. Overall survival (OS) was calculated using the Kaplan-Meier method. Multivariate analysis was done using Cox regression. Results: Factors independently associated with lower surgical referral rates included age >= 65 y (OR 0.29, 95% confidence interval [CI] 0.09-0.89, P = 0.032), bilobar CRLM (OR 0.35, 95% CI 0.09-0.97, P = 0.048), and presence of > 3 CRLM (OR 0.33, 95% CI 0.11-0.94, P = 0.044). The 5-y OS for referred patients was 33% compared with only 8% in patients who were not referred (P < 0.001). Factors independently associated with worse OS included age >= 65 y (hazard ratio [HR] 2.01, 95% CI 1.12-3.59, P = 0.019), bilobar hepatic metastases (HR 3.04, 95% CI 1.62-5.70, P < 0.001), and the presence of extrahepatic metastases (HR 2.11, 95% CI 1.02-4.16, P = 0.011). Referral to a surgeon was associated with improved OS (HR 0.42, 95% CI 0.24-0.74, P = 0.003). Conclusions: Failure to refer CRLM patients for surgical evaluation is associated with aggressive biologic features that do not necessarily preclude resection. Determination of resectability should be made with input from appropriately trained surgical experts. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:198 / 203
页数:6
相关论文
共 25 条
[1]   Patients With Initially Unresectable Colorectal Liver Metastases: Is There a Possibility of Cure? [J].
Adam, Rene ;
Wicherts, Dennis A. ;
de Haas, Robbert J. ;
Ciacio, Oriana ;
Levi, Francis ;
Paule, Bernard ;
Ducreux, Michel ;
Azoulay, Daniel ;
Bismuth, Henri ;
Castaing, Denis .
JOURNAL OF CLINICAL ONCOLOGY, 2009, 27 (11) :1829-1835
[2]  
Aloia TA, 2011, UPDATES SURG-ITALY, V63, P1, DOI 10.1007/s13304-011-0054-y
[3]  
Andreou A, 2011, GASTROINTEST CANC S, V4, P2
[4]  
[Anonymous], SEER STAT FACT SHEET
[5]   Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer [J].
Boland, Genevieve M. ;
Chang, George J. ;
Haynes, Alex B. ;
Chiang, Yi-Ju ;
Chagpar, Ryaz ;
Xing, Yan ;
Hu, Chung-Yuan ;
Feig, Barry W. ;
You, Y. Nancy ;
Cormier, Janice N. .
CANCER, 2013, 119 (08) :1593-1601
[6]   Survival after hepatic resection in metastatic colorectal cancer - A population-based study [J].
Cummings, Linda C. ;
Payes, Jonathan D. ;
Cooper, Gregory S. .
CANCER, 2007, 109 (04) :718-726
[7]   Use of Clinical Score to Stage and Predict Outcome of Hepatic Resection of Metastatic Colorectal Cancer [J].
Feroci, Francesco ;
Fong, Yuman .
JOURNAL OF SURGICAL ONCOLOGY, 2010, 102 (08) :914-921
[8]   Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer - Analysis of 1001 consecutive cases [J].
Fong, Y ;
Fortner, J ;
Sun, RL ;
Brennan, MF ;
Blumgart, LH .
ANNALS OF SURGERY, 1999, 230 (03) :309-318
[9]  
FONG Y, 1995, ANN SURG, V222, P426
[10]   FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial [J].
Heinemann, Volker ;
von Weikersthal, Ludwig Fischer ;
Decker, Thomas ;
Kiani, Alexander ;
Vehling-Kaiser, Ursula ;
Al-Batran, Salah-Eddin ;
Heintges, Tobias ;
Lerchenmueller, Christian ;
Kahl, Christoph ;
Seipelt, Gernot ;
Kullmann, Frank ;
Stauch, Martina ;
Scheithauer, Werner ;
Hielscher, Joerg ;
Scholz, Michael ;
Mueller, Sebastian ;
Link, Hartmut ;
Niederle, Norbert ;
Rost, Andreas ;
Hoeffkes, Heinz-Gert ;
Moehler, Markus ;
Lindig, Reinhard U. ;
Modest, Dominik P. ;
Rossius, Lisa ;
Kirchner, Thomas ;
Jung, Andreas ;
Stintzing, Sebastian .
LANCET ONCOLOGY, 2014, 15 (10) :1065-1075