PROGNOSTIC FACTORS AFTER CRYOTHERAPY FOR HEPATIC METASTASES FROM COLORECTAL-CANCER

Objective To establish the prognostic importance of different patient and tumor characteristics in cryotherapy for liver metastases from col orectal cancer. Summary Background Data Hepatic cryotherapy has been u sed as a treatment of nonresectable liver metastases from colorectal c ancer in almost 1000 patients worldwide, and its safety and efficacy a re well established. However, tumor eventually recurs in most patients and they die of their disease. The knowledge of prognostic factors wo uld allow the selection of patients who are more likely to benefit fro m this treatment and patients who may need additional treatment. Metho ds Between April 1990 and May 1997, 195 patients were treated with hep atic cryotherapy. Out of this group, the authors identified 116 patien ts with colorectal cancer who received cryotherapy for ablation of liv er metastases. Survival was estimated with the Kaplan-Meier method, us ing the log-rank test for univariate analysis for significance of poss ible prognostic factors. For multivariate analysis, a Cox regression w as used. Results One patients (0.9%) died of postoperative myocardial infarction. The total perioperative morbidity rate was 27.6%. Median s urvival and the 5-year survival rate were 26 months and 13.4%. The fol lowing factors were identified as independently associated with a favo rable outcome: low presurgical serum level of carcinoembryonic antigen (CEA), small (less than or equal to 3 cm) diameter of cryoablated met astases, absence of untreated extrahepatic disease at laparotomy, abse nce of nodal involvement at primary resection, complete cryotreatment, synchronous development of liver metastases, and good or moderate dif ferentiation of the primary tumor. Although univariate analysis sugges ted a favorable prognosis in patients who did not receive blood transf usion during surgery and patients younger than 51 years, this was not confirmed in multivariate analysis. In addition, normalization of the serum CEA level after treatment was an important prognostic marker in the subgroup of patients with elevated serum CEA levels before surgery . Conclusions Hepatic cryotherapy is a safe and effective treatment op tion for patients with nonresectable liver metastases from colorectal cancer, with promising results regarding survival. The prognostic fact ors established in this series may allow better patient selection to i mprove the outcome in suitable patients.