Table 7.
Prognostic factors for survival in liver resection for colorectal liver metastases
| Ref. | Prognostic factor | Affected outcome + influence | HR (95%CI) | P value |
| Langella et al[52] | Postoperative complications | Worse 3-yr OS | 3.804 (1.336-10.832) | 0.012 |
| Multiple metastases | 3.421 (1.317-8.890) | 0.012 | ||
| Nomi et al[27] | Synchronous CRLM | Worse OS | 1.482 (0.621-2.859) | 0.023 |
| Positive surgical margin | 2.342 (1.356-2.912) | 0.012 | ||
| Node-positive primary tumor | No difference in OS | 1.857 (0.712-3.459) | 0.382 | |
| Bilobar metastases | 1.398 (0.728-2.458) | 0.298 | ||
| CRLM ≥ 5 cm | 6.813 (2.348-4.245) | 0.351 | ||
| Postriganova et al[28] | Resection margin width (< 1 mm, 1-< 3 mm, 3-< 10 mm and ≥ 10 mm) | No difference in length of survival | - | 0.988 |
| No difference in DFS | - | 0.978 | ||
| No difference in RFS | - | 0.913 | ||
| Tabchouri et al[70] | Node-positive primary tumor | Increased risk of recurrence | 1.611 (1.14-2.28) | 0.007 |
| Extrahepatic disease before hepatectomy | 1.745 (1.24-2.45) | 0.001 | ||
| R1 resection | 1.648 (1.08-2.52) | 0.021 | ||
| Age > 70 yr | Worse survival | 3.157 (1.10-3.10) | 0.021 | |
| Recurrence | 4.637 (1.60-6.26) | 0.002 | ||
| Tohme et al[55] | MILS (vs OLR) | Timely initiation of AC | 2.23 (1.16-4.31) | 0.017 |
| OLR with postoperative complications (vs MILS without complications) | 0.45 (0.23-0.86) | 0.017 | ||
| Number of lesions (solitary vs multiple) | 1.71 (1.14-2.54) | 0.009 | ||
| Length of stay (> 4 vs ≤ 4 d) | 0.64 (0.41-0.99) | 0.043 | ||
| AC more than 60 d after surgery | Worse RFS | 0.05 | ||
| Worse OS | 0.06 | |||
| Topal et al[86] | Fong’s CRS | Worse DFS | 1.46 (1.19-1.78) | 0.0002 |
| Preoperative systemic chemotherapy | 1.70 (1.15-2.52) | 0.008 | ||
| Male sex | Worse OS | 2.54 (1.45-4.45) | 0.001 | |
| Interval systemic chemotherapy and surgery for CRLM | 1.06 (1.01-1.10) | 0.012 | ||
| Fong’s CRS | 1.49 (1.16-1.91) | 0.002 | ||
| Yue et al[39] | TNM stage of primary tumor (III vs I-II) | Worse OS | 1.981 (1.258-3.854) | 0.021 |
| Disease-free interval (< 12 vs ≥ 12 mo) | 1.610 (1.378-2.873) | 0.015 | ||
| Number of metastases (≥3 vs < 3) | 1.500 (1.258-1.870) | 0.041 | ||
| Disease-free interval (< 12 vs ≥ 12 mo) | Worse DFS | 1.874 (1.215-2.001) | 0.036 | |
| Preoperative CEA levels (≥ 5 vs < 5 ng/mL) | 1.740 (1.418-2.108) | 0.028 | ||
| Zeng et al[56] | Disease-free interval (< 36 vs ≥ 36 mo) | 5-yr OS | 2.9871 (2.012-6.980) | 0.009 |
| Disease-free interval (< 36 vs ≥ 36 mo) | 5-yr DFS | 2.9501 (1.895-3.562) | 0.010 | |
| Montalti et al[33] | Lesions located in posterosuperior segments | Worse tumor recurrence | 2.4 (1.24-4.61) | 0.009 |
| Blood loss (≥ 1000 mL vs < 1000 mL) | 3.2 (1.23-7.99) | 0.012 | ||
| R1 margins | No difference in OS | 1.06 (0.57-3.80) | 0.37 | |
| CEA levels (≥ 10 µg/L vs < 10 µg/L) | Worse OS | 4.2 (2.02-16.9) | 0.001 | |
| Multiple lesions (>2 vs ≤2 lesions) | Increased risk of R1 margins | 9.32 (1.14-32.5) | 0.037 | |
| Cervantes et al[98] | CRLM minimum size <9 mm | Worse RFS | 1.6 (1.1-2.4) | < 0.05 |
| Worse hepatic RFS | 1.8 (1.2-3.0) | < 0.05 | ||
| De Haas et al[99] | Development of adrenal metastases after LR | Worse survival | - | 0.020 |
| Jones et al[100] | SUVmean during PET-CT | Insignificant negative effect on OS | 1.053 (0.839-1.321) | 0.659 |
| Log(volume of tumor) | Insignificant negative effect on OS | 1.699 (0.964-2.993) | 0.067 | |
| Ratti et al[101] | Right colonic neoplasms | Worse RFS | 2.382 (1.46-2.75) | 0.042 |
| T-stage of primary tumor (T3-T4) | 1.962 (1.55-3.01) | 0.044 | ||
| RAS mutation | 2.122 (1.33-2.96) | 0.039 | ||
| CRS > 3 | 2.572 (1.68-3.65) | 0.029 | ||
| Absence of perioperative chemotherapy | 2.312 (1.39-3.21) | 0.039 | ||
| Right colonic neoplasms | Worse OS | 2.412 (1.39-2.81) | 0.046 | |
| T-stage of primary tumor (T3-T4) | 1.862 (1.43-2.78) | 0.048 | ||
| RAS mutation | 2.222 (1.42-3.07) | 0.037 | ||
| CRS > 3 | 2.752 (1.83-3.62) | 0.032 | ||
| Absence of perioperative chemotherapy | 2.162 (1.40-3.06) | 0.042 | ||
| Nierop et al[102] | Non-dHGP | Higher risk of positive resection margins | 1.7871 (1.112-2.871) | 0.016 |
| Number of CRLM | 1.1531 (1.077-1.234) | < 0.001 | ||
| Non-dHGP | Worse OS | 1.57 (1.26-1.95) | < 0.001 | |
| Positive resection margins | 1.41(1.13-1.76) | 0.002 | ||
| Age at resection | 1.016 (1.008-1.023) | < 0.001 | ||
| Node positive primary | 1.455 (1.226-1.728) | < 0.001 | ||
| Number of CRLM | 1.078 (1.039-1.118) | < 0.001 | ||
| Size of CRLM | 1.063 (1.035-1.091) | < 0.001 | ||
| Preoperative CEA | No difference in OS | 1.000 (1.000-1.000) | 0.898 |
1
Odds ratio.
2
Risk ratio.
Numbers are presented as median (range) or mean ± SD unless otherwise indicated. AC: Adjuvant chemotherapy; CEA: Carcinoembryonic antigen; CI: Confidence interval; CRLM: Colorectal liver metastases; CRS: Clinical risk score; DFS: Disease-free survival; HR: Hazard ratio; LR: Liver resection; MILS: Minimally invasive surgery; non-dHGP: Non-desmoplastic growth pattern; OLR: Open liver resection; OS: Overall survival; PET-CT: Positron emission tomography-computed tomography; RFS: Recurrence-free survival; SUV: Standard uptake value.