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Synchronous colorectal liver metastases: focus on the elderly

An Effectiveness Study from Routine Care

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Abstract

Purpose

The goal of this study was to analyze the use and the effectiveness of both surgery and different chemotherapies in patients with synchronous colorectal liver metastases (CLMs) ≥70 years compared to younger patients.

Methods

Survival was analyzed in 456 patients (24.3% ≥70 years) treated for CLM in a single center using Kaplan-Meier estimation of overall survival (OS), calculation of relative survival as estimate for disease-specific survival, and a Cox regression model.

Results

Complete surgical resections were achieved more often in patients aged <70 years (39.2 vs. 28.1%, P = 0.056), and young patients more frequently received irinotecan or platin-based chemotherapies (70.3 vs. 41.6%, P < 0.001). Three-year OS and relative survival of patients ≥70 years were significantly lower compared to younger patients (OS 34.3 vs. 43.5%, P = 0.0114). In a Cox regression model, complete surgical removal of liver metastases was the most effective treatment (HR 0.313, P < 0.001) followed by chemotherapy (irinotecan/platin-based: HR 0.371, 5-FU only: HR 0.673, P < 0.001). Having >5 liver metastases, the presence of extrahepatic metastases, high grading, and a nodal positive primary but not age ≥70 years were associated with an increased risk of death.

Conclusions

Our data support radical resection and highly effective chemotherapy in selected elderly patients with CLM.

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Acknowledgements

The authors thank Mrs. Renate Eckel for performing statistical analyses.

Authors’ Contributions Study conception and design: Markus Albertsmeier, Jens Werner, Martin Angele, and Jutta Engel. Acquisition of data: Markus Albertsmeier, Andrea Engel, and Tobias S. Schiergens. Analysis and interpretation of data: Markus Albertsmeier, Markus O. Guba, Gabriele Schubert-Fritschle, Dieter Hölzel, Jens Werner, Jutta Engel, and Martin K. Angele. Drafting of manuscript: Markus Albertsmeier, Andrea Engel, Markus O. Guba, Sebastian Stintzing, and Jutta Engel. Critical revision of manuscript: Tobias S. Schiergens, Gabriele Schubert-Fritschle, Dieter Hölzel, Jens Werner, and Martin K. Angele.

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Author notes

  1. Martin K. Angele and Jutta Engel both authors contributed equally to this publication.

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany

    Markus Albertsmeier, Andrea Engel, Markus O. Guba, Tobias S. Schiergens, Jens Werner & Martin K. Angele

  2. Department of Medical Oncology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany

    Sebastian Stintzing

  3. Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany

    Gabriele Schubert-Fritschle, Dieter Hölzel & Jutta Engel

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  1. Markus Albertsmeier
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Corresponding author

Correspondence to Martin K. Angele.

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Funding

This study did not receive any funding.

Conflict of interest

Sebastian Stintzing received honoraria as a speaker and/or is a member of a medical advisory board for the following companies: Amgen, Roche, Bayer, Merck-Serono, Sanofi, Lilly, and Sirtex. All other authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was carried out in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

In this retrospective registry-based study, informed consent from participants was not required.

Electronic supplementary material

Supplemental Table 1

Multivariate analysis of prognostic factors for overall survival in patients with synchronous colorectal liver metastases. Only patients with single first tumors are included, n = 456. All variables are included in the Cox regression model. CI indicates confidence interval; HR, hazard ratio. (DOCX 30 kb)

Supplemental Table 2

Studies analyzing the efficacy of (A) liver surgery, (B) platin-based chemotherapy and (C) irinotecan in patients ≥70 years compared to patients <70 years. * ≥ 65 years, HR, hazard ratio; n.r., not reported (DOCX 27 kb)

Supplemental Figure 1

Landmark analysis of relative survival depending on the completeness of hepatic metastasectomy (a + b) and chemotherapy (c + d). a + c: age < 70 years. b + d: age ≥ 70 years. 3YRS: 3 year relative survival rate with 95% confidence intervals. The landmark analysis includes only patients surviving >6 months. Survival curves show relative survival adjusted for age. Significance of relative survival differences is not tested statistically but may be derived from non-overlapping confidence intervals. (PPTX 70 kb)

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Albertsmeier, M., Engel, A., Guba, M.O. et al. Synchronous colorectal liver metastases: focus on the elderly. Langenbecks Arch Surg 402, 1223–1232 (2017). https://doi.org/10.1007/s00423-017-1611-8

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  • DOI: https://doi.org/10.1007/s00423-017-1611-8

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