Impact of Liver Directed Therapy in Colorectal Cancer Liver Metastases
Published Date:Jun 04 2014
Source:J Surg Res. 2014; 191(1):42-50.
Aged, 80 And Over
Colorectal Cancer Liver Metastases
Combined Modality Therapy
International Classification Of Diseases
Liver Directed Therapy
Metastatic Colorectal Cancer
Proportional Hazards Models
Vitamin B Complex
Pubmed Central ID:PMC4134714
Funding:T32 DK007639/DK/NIDDK NIH HHS/United States
R24 HS022134/HS/AHRQ HHS/United States
N02 PC015105/PC/NCI NIH HHS/United States
UL1 TR000071/TR/NCATS NIH HHS/United States
N01PC35136/CA/NCI NIH HHS/United States
N01PC35139/CA/NCI NIH HHS/United States
U58 DP000824/DP/NCCDPHP CDC HHS/United States
There is a paucity of data on the current management and outcomes of liver directed therapy (LDT) in older patients presenting with stage IV colorectal cancer (CRC).
To evaluate treatment patterns and outcomes in use of LDT in the setting of improved chemotherapy.
We used Cancer Registry and linked Medicare claims to identify patients ≥66 undergoing surgical resection of the primary tumor and chemotherapy after presenting with stage IV CRC (2001–2007). LDT was defined as liver resection and/or ablative procedures.
We identified 5,500 patients. LDT was used in 34.9% of patients; liver resection was performed in 1,686 patients (30.7%) and locoregional therapy in 554 patients (10.1%), with 322 patients having both resection and ablation/embolization. Use of LDT was negatively associated with increasing year of diagnosis (OR=0.96, 95% CI 0.93–0.99), age >85 (OR=0.61, 95% CI 0.45–0.82), and poor tumor differentiation (OR=0.73, 95% CI 0.64–0.83). LDT was associated with improved survival (median 28.4 vs. 21.1 months, P<0.0001); however, survival improved for all patients over time. We found a significant interaction between LDT and time period of diagnosis and noted a greater survival improvement with LDT for those diagnosed in the late (2005–2007) time period.
Older patients with stage IV CRC are experiencing improved survival over time independent of age, comorbidity and use of LDT. Greater gains in survival are seen with LDT for patients diagnosed in the later time period. These data suggest that improved patient selection may be positively impacting outcomes.
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