Prognostic factors for disease-free survival after preoperative chemotherapy followed by curative resection in patients with colorectal cancer harboring hepatic metastasis: A single-institute, retrospective analysis in Asia

Background: Converting chemotherapy followed by surgery is known to be associated with improved clinical outcomes in colorectal cancer (CRC) patients with hepatic metastasis. This study is to investigate the clinicopathological prognostic factors for disease-free survival (DFS) after curative resection of primary and metastatic lesions. Methods: We retrospectively analyzed the medical records of 76 CRC patients who had initially had unresectable hepatic metastasis, which was considered resectable after systemic chemotherapy, and had undergone curative surgery in the period from January 2006 to December 2011. DFS was compared by assessing clinical data including age, sex, staging, number of hepatic lesion(s), size of the largest hepatic lesion and serum carcinoembryonic antigen (CEA) levels. Results: The median age was 57 years and 47 patients were male. The median DFS was 10.4 months. Multivariate Cox regression analysis revealed that age <50 years (HR 2.70, 95% CI 1.43-5.10, p = 0.002) and CEA elevation after curative surgery (HR 2.20, 95% CI 1.11-4.36, p = 0.023) were associated with a shorter DFS. Conclusions: Given that patients <50 years old or with elevated CEA levels after curative surgery demonstrated a short DFS, additional postoperative systemic treatment or active surveillance, at least, should strongly be considered for this group.