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Impact of Liver Directed Therapy in Colorectal Cancer Liver Metastases
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Jun 04 2014
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Source: J Surg Res. 2014; 191(1):42-50.
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Details:
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Alternative Title:J Surg Res
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Personal Author:
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Description:Background
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).
Objective
To evaluate treatment patterns and outcomes in use of LDT in the setting of improved chemotherapy.
Methods
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.
Results
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.
Conclusions
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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Pubmed ID:24990539
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Pubmed Central ID:PMC4134714
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Volume:191
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Issue:1
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