Ann Surg Treat Res.  2014 Jul;87(1):14-21. 10.4174/astr.2014.87.1.14.

Histopathologic factors affecting tumor recurrence after hepatic resection in colorectal liver metastases

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. gsleenj@hanmail.net
  • 2Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 3Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Hepatic resection is a standard method of treatment for colorectal liver metastases (CRLM). However, the pathologic factors of metastatic lesions that affect tumor recurrence are less well defined in CRLM. The aim of this study was to evaluate the risk factors for recurrence of CRLM, focusing on histopathologic factors of metastatic lesions of the liver.
METHODS
From January 2003 to December 2008, 117 patients underwent curative hepatic resection for CRLM were reviewed. Tumor size and number, differentiation, tumor budding, angio-invasion, dedifferentiation and tumor infiltrating inflammation of metastatic lesions were investigated.
RESULTS
The mean number of hepatic tumors was 2 (range, 1-8). The mean size of the largest tumor was 2.9 cm (range, 0.3-18.5 cm) in diameter. The moderate differentiation of the hepatic tumor was the most common in 86.3% of the patients. Tumor budding, angio-invasion, and dedifferentiation were observed in 81%, 34%, and 12.8% of patients. Inflammation infiltrating tumor was detected in 6.8% of patients. Recurrence after hepatic resection appeared in 69 out of 117 cases (58.9%). Recurrence-free survival at 1, 2 and 5 years were 62.4%, 43.6%, and 34.3%. The multivariate analysis showed the number of metastases > or =3 (P = 0.007), the tumor infiltrating inflammation (P = 0.047), and presence of dedifferentiation (P = 0.020) to be independent risk factors for tumor recurrence.
CONCLUSION
Histopathological factors, i.e., dedifferentiation and tumor infiltrating inflammation of the metastatic lesion, could be one of the risk factors of aggressive behavior as well as the number of metastases even after curative resection for CRLM.

Keyword

Colorectal neoplasm; Liver metastasis; Recurrence; Hepatic resection; Inflammation

MeSH Terms

Colorectal Neoplasms
Humans
Inflammation
Liver*
Multivariate Analysis
Neoplasm Metastasis*
Recurrence*
Risk Factors

Figure

  • Fig. 1 Histology of dedifferentiation. Dedifferentiation was defined as microscopic clusters of tumor cells with large solid sheet (A), palisading pattern (B), cribriform pattern (C), extensive single cells (D) (A-D: H&E, ×200).

  • Fig. 2 Tumor infiltrating inflammation was defined as the presence of tumor infiltrating lymphocytes, neutrophils, or macrophages (arrow) (H&E, ×400).

  • Fig. 3 Overall survival of the 117 patients after hepatic resection for colorectal liver metastases.

  • Fig. 4 Recurrence free survival of the 117 patients after hepatic resection for colorectal liver metastases.


Cited by  2 articles

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Hyunjung Kim, Hae Il Jung, Soon Ha Kwon, Sang Ho Bae, Hyung Chul Kim, Moo-Jun Baek, Moon Soo Lee
Ann Surg Treat Res. 2019;96(4):191-200.    doi: 10.4174/astr.2019.96.4.191.

Long-term Survival in Patients Treated with a Robotic Radiosurgical Device for Liver Metastases
Sebastian Stintzing, Jobst von Einem, Christoph Fueweger, Alfred Haidenberger, Michael Fedorov, Alexander Muavcevic
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