Survival After Combined Hepatic Metastasectomy and Chemotherapy in Patients with Concurrent Hepatic and Extrahepatic Colorectal Metastases: A SEER Database Analysis.

Abstract Purpose: Colorectal cancer is the second leading cause of death among all cancers worldwide. Hepatic metastases exist in about 50% of colorectal cancer patients. The purpose of this study was to assess the effect of combined hepatic metastasectomy and chemotherapy on the overall survival in patients with concurrent hepatic and extra-hepatic disease.Methods: 2533 patients from the US Surveillance, Epidemiology, and End Results (SEER) database with concurrent colorectal liver metastasis (CRLM) and extra-hepatic disease (EHD) between January 1, 2010, and December 31, 2014, were retrieved. Survival analysis with Kaplan-Meier and Cox-regression was performed to assess the effect of combined hepatic metastasectomy and chemotherapy on 5-year survival. Results: Two-hundred and fourteen (8.4%) patients underwent combined hepatic metastasectomy and chemotherapy. The median survival time among patients underwent combined hepatic metastasectomy, and chemotherapy was significantly higher than chemotherapy alone (24 vs. 21 months; p < 0.0001). Furthermore, older age at diagnosis (≥ 60 years), American Indian/Alaska Native race, primary sites at the recto-sigmoid colon, sigmoid colon, and descending colon, grade III, and the presence of bone metastases were all significantly associated with higher 5-year mortality. Patients who underwent combined hepatic metastasectomy and chemotherapy were significantly associated with 22.2% less 5-year mortality compared to patients who received chemotherapy alone. Conclusion: Combined hepatic metastasectomy with chemotherapy in CRLM patients with EHD yields better survival than chemotherapy only.