Impact of liver-directed therapy on survival in patients with colon cancer and isolated hepatic metastases.

Abstract

73 Background: Colon cancer with liver-limited metastases represents a subset of patients (pts) with potentially curable disease. However, survival outcomes vary widely based on pts characteristics and treatment strategies. This study aimed to assess overall survival (OS) and prognostic factors among pts treated with or without liver-directed therapies. Methods: We retrospectively reviewed data from pts with colon cancer and liver-only metastases. Disease and pts characteristics were collected. Pts received hepatic resection (HR), radio-frequency ablation (RFA), or no liver-directed therapy. Neoadjuvant chemotherapy (NAC) was given to selected pts. OS was estimated using Kaplan-Meier methods, and factors associated with OS were evaluated using log-rank tests. Results: A total of 117 pts were included. The median age at diagnosis was 58 years (range 24-87). ECOG performance status at diagnosis was 0 in 38 pts (32.5%), 1 in 65 (55.6%), 2 in 12 (10.3%), and 3 in 2 pts (1.7%). The primary tumor site was right sided in 26 pts (22.2%), left in 73 (62.4%), and rectal in 16 (13.7%). Liver metastases were metachronous in 80 pts (68.4%), and synchronous in 36 (30.8%). The median maximum size of liver lesions was 2.6cm (0.4 - 15.3cm). The number of liver lesions was 1 in 40 pts (34.2%), 2 in 36 pts (30.8%), 3 in 16 pts (13.7%), and 4 or more in 22 pts (18.8%). Local liver-directed therapy consisted of HR in 41 pts (35%), RFA in 28 pts (23.9%), and no local treatment in 48 pts (41%). NAC was administered to 57 pts (48.7%), of whom 14 received bevacizumab, and 13 received an anti-EGFR agent. The median follow up period was 48.1 months (m) (95% CI; 43.1 - 53.8). The median OS for the whole cohort was 48.1 m (95% CI; 44.7 - 55.5). Median OS for the HR group was 66.8 m (95%CI: 41.9 - 91.7), whereas it was 45 m (95%CI: 24.7-65.2) for the RFA group, and 34.4 m (95%CI: 27.6 - 41.2) for the group without local therapy (P = 0.004). Worse OS was associated with age >65 years (P<0.001), higher ECOG/PS (P<0.001), elevated CEA (P=0.04), and higher number of liver metastases (P=0.004). No significant associations were found for BMI (P=0.82), comorbidities (P=0.74), and use of NAC (P=0.54). Conclusions: HR is associated with superior survival in pts with colon cancer and liver-limited metastases. Age, performance status, and number of liver metastases are key prognostic indicators. Careful patient selection is critical to improving outcomes.