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Actual 10-Year Survival After Resection of Colorectal Liver Metastases Defines Cure

James S. Tomlinson, William R. Jarnagin, Ronald P. DeMatteo, Yuman Fong, Peter Kornprat, Mithat Gonen, Nancy Kemeny, Murray F. Brennan, Leslie H. Blumgart, Michael D'Angelica

From the Departments of Surgery, Epidemiology and Biostatistics, and Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY; Division of Surgical Oncology, University of California, Los Angeles, Greater Los Angeles Healthcare System, Los Angeles, CA; and Department of Surgery, Medical University of Graz, Graz, Austria

Address reprint requests to Michael D'Angelica, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; e-mail: dangelim{at}mskcc.org

Purpose Resection of colorectal liver metastases (CLM) in selected patients has evolved as the standard of care during the last 20 years. In the absence of prospective randomized clinical trials, a survival benefit has been deduced relative to historical controls based on actuarial data. There is now sufficient follow-up on a significant number of patients to address the curative intent of resecting CLM.

Methods Retrospective review of a prospectively maintained database was performed on patients who underwent resection of CLM from 1985 to 1994. Postoperative deaths were excluded. Disease-specific survival (DSS) was calculated from the time of hepatectomy using the Kaplan-Meier method.

Results There were 612 consecutive patients identified with 10-year follow-up. Median DSS was 44 months. There were 102 actual 10-year survivors. Ninety-nine (97%) of the 102 were disease free at last follow-up. Only one patient experienced a disease-specific death after 10 years of survival. In contrast, 34% of the 5-year survivors suffered a cancer-related death. Previously identified poor prognostic factors found among the 102 actual 10-year survivors included 7% synchronous disease, 36% disease-free interval less than 12 months, 25% bilobar metastases, 50% node-positive primary, 39% more than one metastasis, and 35% tumor size more than 5 cm.

Conclusion Patients who survive 10 years appear to be cured of their disease, whereas approximately one third of actual 5-year survivors succumb to a cancer-related death. In well-selected patients, there is at least a one in six chance of cure after hepatectomy for CLM. The presence of poor prognostic factors does not preclude the possibility of long-term survival and cure.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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