THE PROGNOSTIC VALUE OF EXTENT OF PORTAL VEIN INVASION IN PATIENTS WITH SURGICALLY RESECTED COLORECTAL LIVER METASTASIS
Keiichi Akahoshi*, Satoshi Nara, Yoji Kishi, Minoru Esaki, Kazuaki Shimada
Hepatobiliary and Pancreatic Surgery division,, National Cancer Center Hospital, Tokyo, Japan
[Introduction] Portal vein invasion (PVI, including tumor thrombus) is rare in colorectal liver metastasis (CRLM), in contrast to hepatocellular carcinoma (HCC). The incidence and prognostic value of PVI in CRLM have not yet been clarified.
[Methods] The data of 966 patients who underwent hepatectomy for CRLM between 1990 and 2016 was retrospectively analyzed. The extent of PVI (vp) was assessed according to the general rules for clinical and pathological study of primary liver cancer of Japan. The prognosis and clinicopathological features of patients with vp0, vp1 (microscopic PVI) and vp2/3/4 (macroscopic PVI) were compared.
[Results] Among 966 patients, vp0, vp1, vp2, vp3, and vp4 were observed in 730 cases (76%), 216 cases (22%), 15 cases (1.6%), 4 cases (0.4%) and 1 case (0.1%), respectively. The 5-year overall survival rates of vp0, vp1, vp2 and vp3/4 were 58%, 33%, 0% and 0%, and median survival time was 2293, 1188, 621 and 453 days, respectively. The presence and increased extent of PVI were associated with poor prognosis. PVI was frequently seen in patients with metachronous liver metastasis (p=0.03), multiple tumors (p=0.001), residual tumor (p=0.001) and high carcinoembryonic antigen levels (p=0.018). Multivariate analysis of overall survival demonstrated that the presence of PVI (Hazard ratio [HR] 4.852; 95% confidence interval [CI] 2.557-9.204; p=0.001), multiple tumor (HR 1.378; 95 % CI 1.139-1.667; p=0.001) and residual tumor (R1/2) (HR 2.095; 95 % CI 1.605-2.659; p =0.001) were independent poor prognostic factors.
[Conclusion]
The presence of PVI was a potent poor prognostic factor of OS and RFS. Thus, careful follow-up is necessary in patients with PVI, especially with macroscopic PVI. Evaluation of extent of PVI may contribute to the optimization of adjuvant chemotherapy in patients with CRLM.
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