Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon or rectum

Abstract

The median survival of all patients with hepatic metastases from colorectal cancer referred to the Sidney Farber Cancer Institute [Massachusetts, USA] during a 5-yr period was 12.5 mo. Two major factors influenced survival. The 1st was extent of disease at presentation. The 2nd was the histologic grade of the cancer. The median survival of patients presenting with the least disease, characterized by < 4 liver nodules visible on liver scan (n = 38), normal liver size on physical examination (n = 60), normal liver function test results (n = 30) and normal performance status (n = 91), was between 18-24 mo., regardless of treatment. The median survival of those few patients (13) who had objective responses to a variety of treatments, most of whom also had minimal disease at presentation, was also 24 mo. Patients whose tumors were poorly differentiated or who had abnormal performance status or weight loss of > 10% at presentation survived only 6 mo. (median). Those with 4 or more liver nodules, hepatomegaly (> 16-cm vertical span on physical examination) or abnormal liver function test results, survived 10, 8 and 12 mo. (median), respectively. A significant group of patients survived longer than would have been predicted by earlier literature surveys after the diagnosis of colorectal cancer metastatic to the liver. Future therapeutic trials, using survival as a measure of response of patients with liver metastases from colorectal cancer, must be prospectively controlled before selection factors can be differentiated from significant therapy effect.