Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1984 Mar;199(3):317–324. doi: 10.1097/00000658-198403000-00011

Multivariate analysis of a personal series of 247 patients with liver metastases from colorectal cancer. II. Treatment by intrahepatic chemotherapy.

J G Fortner, J S Silva, E B Cox, R B Golbey, H Gallowitz, B J Maclean
PMCID: PMC1353398  PMID: 6703793

Abstract

One hundred and seventeen patients with colorectal hepatic metastases had insertion of catheters for infusional chemotherapy. The two-year survival estimate of patients with less than 50% hepatic replacement and no other adverse factors was 37%. Nine of 39 patients in this group are alive at 24 months. The catheters were placed into the hepatic artery (HA), 23; into the portal venous system (PV), 18; into both HA and PV, 64; or into an accessory HA following ligation, 12. Fifty-nine patients had ligation of the common HA also. The 30-day postoperative mortality rate was 1.7% (2/117) and morbidity was 37.6%. The majority of complications were related to fever (61%, 27/44). Over the past 2 years, 87% of patients have been discharged within 10 days following surgery. Preoperative CEA ranged from 0.5-12,150 ng/ml (median 165 ng/ml); 93% (78/84) had plasma CEA levels exceeding 5 ng/ml. All patients had careful intraoperative staging: per cent hepatic replacement (PHR) ranged from 5-95% (median 60%); portal, celiac, or periaortic lymph node metastases were observed in 31% (36/117). Initial intrahepatic chemotherapy programs consisted of either CAMF (9 patients), MAFL (60 patients), BFS (22 patients), continuous infusion FUDR (14 patients), or miscellaneous drugs (4 patients). Median survival time of 109 evaluable patients was 11.5 months. The effect of 20 variables on the observed survival time was analyzed using a multivariate proportional hazard model. Three variables were found to have influenced survival: PHR emerged as the most significant, p = 0.000001. Increased PHR was associated with decreased survival time. Lymph node metastases and prior chemotherapy were prognostic factors also, p = 0.0006 and p = 0.03, respectively. No patient with PHR greater than 80% lived more than 8 months. Utilization of these variables would appear to be necessary for accurate stratification and evaluation of future chemotherapy trials in patients with colorectal hepatic metastases.

Full text

PDF
319

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Almersjö O., Bengmark S., Hafström L., Leissner K. H. Results of liver dearterialization combined with regional infusion of 5-fluorouracil for liver cancer. Acta Chir Scand. 1976;142(2):131–138. [PubMed] [Google Scholar]
  2. Almersjö O., Bengmark S., Rudenstam C. M., Hafström L., Nilsson L. A. Evaluation of hepatic dearterialization in primary and secondary cancer of the liver. Am J Surg. 1972 Jul;124(1):5–9. doi: 10.1016/0002-9610(72)90155-9. [DOI] [PubMed] [Google Scholar]
  3. Bengmark S., Hafström L. The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer. 1969 Jan;23(1):198–202. doi: 10.1002/1097-0142(196901)23:1<198::aid-cncr2820230126>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  4. Bengtsson G., Carlsson G., Hafström L., Jönsson P. E. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981 May;141(5):586–589. doi: 10.1016/0002-9610(81)90057-x. [DOI] [PubMed] [Google Scholar]
  5. Cady B., Oberfield R. A. Regional infusion chemotherapy of hepatic metastases from carcinoma of the colon. Am J Surg. 1974 Feb;127(2):220–227. doi: 10.1016/0002-9610(74)90161-5. [DOI] [PubMed] [Google Scholar]
  6. Cady B., Oberfield R. A. Regional infusion chemotherapy of hepatic metastases from carcinoma of the colon. Am J Surg. 1974 Feb;127(2):220–227. doi: 10.1016/0002-9610(74)90161-5. [DOI] [PubMed] [Google Scholar]
  7. Davis H. L. Chemotherapy of large bowel cancer. Cancer. 1982 Dec 1;50(11 Suppl):2638–2646. [PubMed] [Google Scholar]
  8. Ensminger W. D., Rosowsky A., Raso V., Levin D. C., Glode M., Come S., Steele G., Frei E., 3rd A clinical-pharmacological evaluation of hepatic arterial infusions of 5-fluoro-2'-deoxyuridine and 5-fluorouracil. Cancer Res. 1978 Nov;38(11 Pt 1):3784–3792. [PubMed] [Google Scholar]
  9. Fortner J. G., Mulcare R. J., Solis A., Watson R. C., Golbey R. B. Treatment of primary and secondary liver cancer by hepatic artery ligation and infusion chemotherapy. Ann Surg. 1973 Aug;178(2):162–172. doi: 10.1097/00000658-197308000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fortner J. G., Pahnke L. D. A new method for long term intrahepatic chemotherapy. Surg Gynecol Obstet. 1976 Dec;143(6):979–980. [PubMed] [Google Scholar]
  11. Fortner J. G., Silva J. S., Golbey R. B., Cox E. B., Maclean B. J. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg. 1984 Mar;199(3):306–316. doi: 10.1097/00000658-198403000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Goslin R., Steele G., Jr, Zamcheck N., Mayer R., MacIntyre J. Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon or rectum. Dis Colon Rectum. 1982 Nov-Dec;25(8):749–754. doi: 10.1007/BF02553304. [DOI] [PubMed] [Google Scholar]
  13. Jaffe B. M., Donegan W. L., Watson F., Spratt J. S., Jr Factors influencing survival in patients with untreated hepatic metastases. Surg Gynecol Obstet. 1968 Jul;127(1):1–11. [PubMed] [Google Scholar]
  14. Kemeny N., Yagoda A., Braun D., Jr, Golbey R. Therapy for metastatic colorectal carcinoma with a combination of methyl-CCNU, 5-fluorouracil vincristine and streptozotocin (MOF-Strep). Cancer. 1980 Mar 1;45(5):876–881. doi: 10.1002/1097-0142(19800301)45:5<876::aid-cncr2820450509>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  15. Kim D. K., McSweeney J., Yeh S. D., Fortner J. G. Tumors of the liver as demonstrated by angiography, scan and laparotomy. Surg Gynecol Obstet. 1975 Sep;141(3):409–410. [PubMed] [Google Scholar]
  16. Kim D. K., Penneman R., Kallum B., Carrillo M., Scheiner E., Fortner J. G. Acute renal failure after ligation of the hepatic artery. Surg Gynecol Obstet. 1976 Sep;143(3):391–394. [PubMed] [Google Scholar]
  17. Kim D. K., Watson R. C., Pahnke L. D., Fortner J. G. Tumor vascularity as a prognostic factor for hepatic tumors. Ann Surg. 1977 Jan;185(1):31–34. doi: 10.1097/00000658-197701000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Moertel C. G. Clinical management of advanced gastrointestinal cancer. Cancer. 1975 Aug;36(2):675–682. doi: 10.1002/1097-0142(197508)36:2+<675::aid-cncr2820360810>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  19. Moertel C. G., Schutt A. J., Hahn R. G., Reitemeier R. J. Therapy of advanced colorectal cancer with a combination of 5-fluorouracil, methyl-1,3-cis(2-chlorethyl)-1-nitrosourea, and vincristine. J Natl Cancer Inst. 1975 Jan;54(1):69–71. doi: 10.1093/jnci/54.1.69. [DOI] [PubMed] [Google Scholar]
  20. Oberfield R. A., McCaffrey J. A., Polio J., Clouse M. E., Hamilton T. Prolonged and continuous percutaneous intra-arterial hepatic infusion chemotherapy in advanced metastatic liver adenocarcinoma from colorectal primary. Cancer. 1979 Aug;44(2):414–423. doi: 10.1002/1097-0142(197908)44:2<414::aid-cncr2820440207>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  21. Pettavel J., Morgenthaler F. Protracted arterial chemotherapy of liver tumors: an experience of 107 cases over a 12-year period. Prog Clin Cancer. 1978;7:217–233. [PubMed] [Google Scholar]
  22. Pettavel J., Morgenthaler F. Protracted arterial chemotherapy of liver tumors: an experience of 107 cases over a 12-year period. Prog Clin Cancer. 1978;7:217–233. [PubMed] [Google Scholar]
  23. Reed M. L., Vaitkevicius V. K., Al-Sarraf M., Vaughn C. B., Singhakowinta A., Sexon-Porte M., Izbicki R., Baker L., Straatsma G. W. The practicality of chronic hepatic artery infusion therapy of primary and metastatic hepatic malignancies: ten-year results of 124 patients in a prospective protocol. Cancer. 1981 Jan 15;47(2):402–409. doi: 10.1002/1097-0142(19810115)47:2<402::aid-cncr2820470231>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  24. Sundqvist K., Hafström L. O., Jönsson P. E., Rydén S., Forsberg L., Lunderquist A. Treatment of liver cancer with regional intraarterial 5-FU infusion. Am J Surg. 1978 Sep;136(3):328–331. doi: 10.1016/0002-9610(78)90286-6. [DOI] [PubMed] [Google Scholar]
  25. Wood C. B., Gillis C. R., Blumgart L. H. A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol. 1976 Sep;2(3):285–288. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES