Echogenicity of liver metastases is an independent prognostic factor after potentially curative treatment

Hypothesis: Intraoperative echogenic appearance of liver metastases from colorectal cancer is a prognostic factor of outcome after curative treatment. Design: Retrospective analysis of prospectively collected data. Setting: Department of Surgery at a university hospital. Patients: One hundred forty-three consecutive patients with hepatic metastases from colorectal cancer who underwent liver resection with curative intent between 1992 and 1998. Intervention: Curative treatment was achieved by liver resection alone, liver resection plus edge cryotherapy, or liver resection plus cryotherapy to lesions not amenable to further resection. In patients with more than 2 lesions, a hepatic artery catheter was placed for regional chemotherapy. Main Outcome Measures: The echogenic appearance of the liver metastases was assessed by intraoperative ultrasound by a single person throughout the study using a 5-MHz ultrasound probe. The findings were prospectively entered into the database. Results: Fifty-four percent of patients had hyperechoic metastases. This group had significantly longer overall (log rank, P<.001) and recurrence-free survival Clog rank, P=.004) compared with patients who had hypoechoic metastases (36%). A significantly higher percentage of mucin-secreting tumors were found in the hypoechoic patient group (<chi>(2), P=.001). Dukes stage of the primary tumor (P=.02), echogenicity of the liver secondaries (P=.04), and diameter of the largest resected metastasis (P=.01) were independent prognostic factors for recurrence-free survival in the Cox regression model. Conclusion: These results support the hypothesis that echogenicity of liver metastases from colorectal cancer is an independent prognostic factor of outcome after curative resection.