Echogenicity of liver metastases is an independent prognostic factor afterpotentially curative treatment

Hypothesis: Intraoperative echogenic appearance of liver metastases from co lorectal cancer is a prognostic factor of outcome after curative treatment. Design: Retrospective analysis of prospectively collected data. Setting: Department of Surgery at a university hospital. Patients: One hundred forty-three consecutive patients with hepatic metasta ses from colorectal cancer who underwent liver resection with curative inte nt between 1992 and 1998. Intervention: Curative treatment was achieved by liver resection alone, liv er resection plus edge cryotherapy, or liver resection plus cryotherapy to lesions not amenable to further resection. In patients with more than 2 les ions, a hepatic artery catheter was placed for regional chemotherapy. Main Outcome Measures: The echogenic appearance of the liver metastases was assessed by intraoperative ultrasound by a single person throughout the st udy using a 5-MHz ultrasound probe. The findings were prospectively entered into the database. Results: Fifty-four percent of patients had hyperechoic metastases. This gr oup had significantly longer overall (log rank, P<.001) and recurrence-free survival Clog rank, P=.004) compared with patients who had hypoechoic meta stases (36%). A significantly higher percentage of mucin-secreting tumors w ere found in the hypoechoic patient group (<chi>(2), P=.001). Dukes stage o f the primary tumor (P=.02), echogenicity of the liver secondaries (P=.04), and diameter of the largest resected metastasis (P=.01) were independent p rognostic factors for recurrence-free survival in the Cox regression model. Conclusion: These results support the hypothesis that echogenicity of liver metastases from colorectal cancer is an independent prognostic factor of o utcome after curative resection.