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Outcomes of geriatric population with resectable colorectal liver metastases cancer: Data from real life
Background
In selected patients with metastatic colorectal cancer (mCRC), resection of liver metastasis (LM) is the only potential curative option. The geriatric population is often underrepresented in clinical trials, leading to extrapolation of data from younger and healthier patients. Age is often considered a risk factor for poorer postoperative outcomes. The aim of this study was to evaluate the outcomes of older patients with resectable LM undergoing liver resection.
Methods
Retrospective analysis of patients with mCRC, with age ≥65 years (n=36), followed at our center, who underwent liver metastasectomy with curative intent and who underwent primary chemotherapy between March 2004 and June 2017.
Results
The median age at diagnosis was 70 (65-79) and 72,2% were men. All patients had ECOG PS 0-1. The primary tumour was in colon in 26 (72,2%) patients (19,4% in rigth colon) and in 10 patients in rectum (27,8%). 41,7% was RAS mutated. The LM in 55.6% (n=20) patients was synchronous and 44.4% (n=16) was metachronous. The median time to LM in the metachronous subgroup was 11 months [4-56]. In 30,6% patients, the LM was initially unresectable (27,8% for multinodularity). 58,3% of the patients (n=21) had >2 LM and the size of metastases was ≥60 mm in 41,7% of the patients (n=15). All the patients underwent conversion chemotherapy before hepatic resection, in 72,2% of patients with a duplet – FOLFIRI in 38,9%. Biological agent was associated in 38,9% - bevacizumab in 16,7%, cetuximab in 16,7% and panitumumab in 5,5% patients. As G3 toxicity of biological agents, only arterial hypertension was reported in 2,8% (n=1) patients associated with bevacizumab. Metastasectomy was performed in 50% patients (n=18) and hepatectomy in 22,2% patients (n=8). The median number of LM resected was 2 [0,6] and was < 50 mm in 66,7% patients (n=24) and histopathologic surgical margins were R0 in 75% patients (n=27). There was a parcial pathological response in 33,3 % patients and complete response in 8,3%. There were surgical complications in 13,9% patients (n=5) – 8,3% delayed cicatrization, 2,8% hemorrhagic, 2,8% infectious, and 2,8% fistulization. Chemotherapy after hepatic resection was performed in 88,9% of patients (n=32), 63,9% a duplet. The median number of cycles of chemotherapy was 6. The median follow-up time from the date of diagnosis was 72,5 months [20, 142]. The median disease-free survival after metastasectomy was 15 months [2,122]. 61,1% of patients had liver recurrence (n=22) and 13,9% performed a new metastasectomy (n=5). The median overall survival after metastasectomy was 51,5 months [4-133]. 63,9% patients died during the follow-up time (n=23) and 27,8% remain on surveillance.
Conclusions
Despite we cannot have definitive conclusions due to sample size and retrospective nature of the data analysis, these results are according with the literature regarding toxicity profile and survival outcomes of elderly patients treated with liver metastasectomy. Age should not be a limiting factor in the curative management of older patients with resectable LM. In the continuation of this study, in a prospective context, the geriatric evaluation, such as the G-8 screening tool, would be important.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
