The Role of Chemotherapy in Patients with Synchronous Colorectal Liver Metastases: A Nationwide Study
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. National Quality Registries
2.3. Work-Up of Patients
2.4. Permissions
2.5. Statistics
3. Results
3.1. Surgical Results and Morbidity
3.2. Overall Survival and Cox Regression Analysis
3.3. Sub-Group Analyses
3.4. Supplemental Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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No. Patients | Neoadjuvant | Upfront Surgery | p Value | |
---|---|---|---|---|
n = 2072 | n = 1238 | n = 834 | ||
Age (years) | ||||
Median (IQR) | 66 (58–72) | 65 (57–70) | 70 (60–71) | <0.001 |
Age > 70 | 747 (36) | 343 (28) | 404 (48) | <0.001 |
Sex | ||||
Men | 1269 (61) | 765 (62) | 504 (60) | 0.282 |
Women | 803 (39) | 473 (38) | 330 (40) | |
ASA | ||||
1 | 289 (17) | 206 (19) | 83 (14) | 0.006 |
2 | 947 (57) | 631 (57) | 316 (55) | |
3 | 419 (25) | 249 (23) | 170 (29) | |
4 | 21 (1) | 12 (1) | 9 (2) | |
Missing | 396 | 140 | 256 | |
T category of primary cancer | ||||
T1 | 21 (1) | 13 (1) | 8 (1) | 0.027 |
T2 | 137 (8) | 98 (9) | 39 (7) | |
T3 | 1045 (62) | 692 (64) | 353 (60) | |
T4 | 476 (29) | 284 (26) | 192 (32) | |
Tx/missing 592 | 393 | 151 | 242 | |
Lymphatic spread of primary cancer | ||||
N0 | 503 (30) | 308 (28) | 195 (33) | 0.006 |
N1 | 642 (38) | 449 (40) | 193 (33) | |
N2 | 557 (32) | 356 (32) | 201 (34) | |
Nx/missing | 370 | 125 | 245 | |
Tumor diameter (mm) | 20 (13–33) | 20 (14–35) | 20 (13–30) | 0.019 |
Median (IQR) | ||||
Number of liver metastases | ||||
1 | 666 (35) | 328 (28) | 338 (47) | <0.001 |
2 | 372 (19) | 249 (21) | 123 (17) | |
3–5 | 502 (26) | 373 (31) | 129 (18) | |
6 | 253 (13) | 181 (15) | 72 (10) | |
>6 | 118 (6) | 56 (5) | 62 (9) | |
Missing | 161 | 51 | 110 |
Neoadjuvant | Upfront Surgery | p Value | |
---|---|---|---|
n = 1238 | n = 834 | ||
Emergency primary cancer operation | 99 (12) | 0.059 | |
144 (12) | |||
Type of colorectal resection | |||
Rectal resection | 392 (32) | 141 (17) | <0.001 |
Left colectomy | 423 (34) | 195 (23) | |
Right colectomy | 232 (19) | 194 (23) | |
Colectomy, other | 62 (5) | 37 (4) | |
Unspecified | 117 (10) | 225 (27) | |
Laparotomy only | 42 (1) | 42 (5) | |
Major hepatectomy | |||
3 or more liver segments | 527 (43) | 50 (6) | <0.001 |
Intraoperative blood loss | |||
Median (IQR) | 600 (300–1100) | 300 (125–475) | 0.083 |
Response on neoadjuvant treatment | |||
Complete/partial | 481 (39) | ||
Stable disease | 98 (8) | N/A | |
Progress | 34 (3) | ||
Unclear | 625 (50) | ||
Liver resection | |||
R0 | 898 (81) | 298 (80) | 0.39 |
R1 | 125 (11) | 36 (10) | |
Unclear | 89 (8) | 37 (10) | |
Missing | 126 | 463 | |
Post-operative complications | |||
Re-admission within 30 days | 81 (7) | 36 (4) | <0.001 |
Clavien Dindo 3a | 87 (7) | 25 (3) | <0.001 |
Clavien–Dindo 3b | 41 (3) | 16 (2) | |
Clavien–Dindo 4a | 15 (1) | 5 (1) | |
Clavien–Dindo 4b | 4 (0) | 2 (0) | |
Clavien–Dindo 5 | 5 (0) | 2 (0) |
(a) | |||||
---|---|---|---|---|---|
Univariable | p Value | Multivariable | p Value | ||
HR, 95% CI | HR, 95% CI | ||||
Age (years) | |||||
<70 | Reference | Reference | |||
≥70 | 1.38 (1.26–1.56) | <0.001 | 1.46 (1.25–1.70) | 0.007 | |
Gender | |||||
Women | Reference | Reference | |||
Men | 1.05 (0.90–1.11) | 0.931 | 1.03 (0.89–1.19) | 0.719 | |
ASA | |||||
1–2 | Reference | Reference | |||
3–4 | 1.26 (1.09–1.46) | 0.002 | 1.16 (0.98–1.38) | 0.087 | |
T category of primary cancer | |||||
T1–T2 | Reference | Reference | |||
T3–T4 | 1.91 (1.53–2.39) | <0.001 | 1.41 (1.09–1.84) | 0.010 | |
Lymphatic spread of primary cancer | |||||
N0 | Reference | Reference | |||
N1–N2 | 1.89 (1.64–2.16) | <0.001 | 1.68 (1.41–1.99) | <0.001 | |
Number of liver metastases | |||||
1 | Reference | ||||
2 | 1.33 (1.13–1.56) | <0.001 | 1.52 (1.26–1.84) | <0.001 | |
3–5 | 1.40 (1.21–1.63) | <0.001 | 1.38 (1.14–1.66) | <0.001 | |
6 | 1.80 (1.51–2.15) | <0.001 | 1.54 (1.22–1.96) | <0.001 | |
>6 | 3.04 (2.44–3.79) | <0.001 | 2.05 (1.38–3.01) | <0.001 | |
Chemotherapy | |||||
Upfront surgery | Reference | ||||
Neoadjuvant | 0.56 (0.51–0.63) | <0.001 | 1.04 (0.86–1.26) | 0.681 | |
No adjuvant | Reference | ||||
Adjuvant | 0.62 (0.55–0.69) | <0.001 | 0.80 (0.69–0.94) | 0.007 | |
(b) | |||||
Univariable | p Value | Multivariable | p Value | ||
HR, 95% CI | HR, 95% CI | ||||
Age (years) | |||||
<70 | Reference | Reference | |||
≥70 | 1.61 (1.25–2.07) | <0.001 | 1.93 (1.30–2.87) | 0.002 | |
Gender | |||||
Women | Reference | Reference | |||
Men | 0.99 (0.78–1.25) | 0.928 | 1.21 (0.82–1.76) | 0.335 | |
ASA | |||||
1–2 | Reference | Reference | |||
3–4 | 1.33 (0.95–1.86) | 0.094 | 1.58 (1.06–2.36) | 0.026 | |
T category of primary cancer | |||||
T1–T2 | Reference | Reference | |||
T3–T4 | 3.81 (1.87–7.73) | <0.001 | 3.30 (1.53–7.11) | 0.002 | |
Lymphatic spread of primary cancer | |||||
N0 | Reference | Reference | 0.241 | ||
N1–N2 | 1.94 (1.33–2.83) | <0.001 | 1.34 (0.82–2.17) | ||
Chemotherapy | |||||
Upfront surgery | Reference | Reference | |||
Neoadjuvant | 0.301 (0.24–0.38) | <0.001 | 1.53 (0.67–3.53) | 0.314 | |
No adjuvant | Reference | Reference | |||
Adjuvant | 0.70 (0.54–0.90) | 0.005 | 1.06 (0.72–1.54) | 0.778 |
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Sternby, H.; Brandt, F.; Sanjeevi, S.; Unosson, J.; Reda, S.; Muszynska, C.; Urdzik, J.; Frühling, P. The Role of Chemotherapy in Patients with Synchronous Colorectal Liver Metastases: A Nationwide Study. Cancers 2025, 17, 970. https://doi.org/10.3390/cancers17060970
Sternby H, Brandt F, Sanjeevi S, Unosson J, Reda S, Muszynska C, Urdzik J, Frühling P. The Role of Chemotherapy in Patients with Synchronous Colorectal Liver Metastases: A Nationwide Study. Cancers. 2025; 17(6):970. https://doi.org/10.3390/cancers17060970
Chicago/Turabian StyleSternby, Hanna, Farima Brandt, Srinivas Sanjeevi, Jon Unosson, Souheil Reda, Carolina Muszynska, Jozef Urdzik, and Petter Frühling. 2025. "The Role of Chemotherapy in Patients with Synchronous Colorectal Liver Metastases: A Nationwide Study" Cancers 17, no. 6: 970. https://doi.org/10.3390/cancers17060970
APA StyleSternby, H., Brandt, F., Sanjeevi, S., Unosson, J., Reda, S., Muszynska, C., Urdzik, J., & Frühling, P. (2025). The Role of Chemotherapy in Patients with Synchronous Colorectal Liver Metastases: A Nationwide Study. Cancers, 17(6), 970. https://doi.org/10.3390/cancers17060970