Recurrent Colorectal Liver Metastasis Patients Would Benefit to Repeat Hepatic Resection

Abstract Background Local treatment remains the best option for recurrent colorectal liver metastasis. The current study aims to investigate predictive factors of survival outcomes and select candidates of local treatment for CRLM at first recurrence. Methods Data were collected retrospectively on CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram to predict overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index and calibration curve. Results Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated to be resectable and liver-limited disease. Among of them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients only received systemic chemotherapy. Multivariable analysis identified node-positive primary, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment were independent risk factors for survival outcome. Integrating these five variables, the nomogram showed good concordance statistics of 0.707. Compared with patients who only received systemic chemotherapy, radical local treatment did not improve survival outcome significantly (median OS: 21 vs. 15 months, p = 0.126) in high risk group (total score above 13). Conclusion Radical local treatment is crucial to prolong the survival of recurrent CRLM patients. The proposed model facilitates personalized assessment of prognosis for patients who developed first recurrence in liver.