Embryonic Origin of Primary Colon Cancer Predicts Survival in Patients Undergoing Ablation for Colorectal Liver Metastases

Publication date: Available online 29 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Suguru Yamashita, Bruno C. Odisio, Steven Y. Huang, Scott E. Kopetz, Kamran Ahrar, Yun Shin Chun, Claudius Conrad, Thomas A. Aloia, Sanjay Gupta, Samer Harmoush, Marshall E. Hicks, Jean-Nicolas Vauthey
BackgroundIn patients with primary colorectal cancer (CRC) or unresectable metastatic CRC, midgut embryonic origin of the tumor is associated with worse prognosis. The impact of embryonic origin on survival after ablation of colorectal liver metastases (CLM) is unclear.MethodsWe identified 74 patients with CLM who underwent image-guided percutaneous liver ablation during 2004-2015. Survival and recurrence after ablation of CLM from midgut origin (n=18) and hindgut origin tumors (n=56) were analyzed. Prognostic value of embryonic origin was evaluated by multivariable analysis.ResultsRecurrence-free survival (RFS) and overall survival (OS) after hepatic resection were worse in patients with CLM from midgut origin tumors (3-year RFS rate: 5.6% vs. 24%, P=0.004; 3-year OS rate: 25% vs. 70%, P<0.001). In Cox proportional hazards regression analysis, factors associated with worse OS were midgut embryonic origin (hazard ratio [HR] 4.87, 95% CI 2.14-10.9, P<0.001), multiple CLM (HR 2.35, 95% CI 1.02-5.39, P=0.044), and RAS mutation (HR 2.78, 95% CI 1.25-6.36, P=0.013). At a median follow-up of 25 months, 56 patients (76%) had developed a recurrence, 16 (89%) with midgut origin and 40 (71%) with hindgut origin tumors (P=0.133). Recurrent disease was treated with local therapy in 20 patients (36%), 2 (13%) with midgut origin and 18 (45%) with hindgut origin tumors (P=0.022).ConclusionCompared to CLM from hindgut origin tumors, CLM from midgut origin tumors were associated with worse survival after ablation, which was partly attributable to the fact that patients with hindgut origin tumors were more frequently candidates for local therapy at recurrence.



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