BACKGROUND: Metachronous liver metastasis (MLM) occurs in 20-40% of colorectal cancer (CRC) patients following surgical treatment. The aim of the present study was to determine the risk factors affecting the development of MLM in CRC patients following curative resection. METHODS: A total of 1,356 patients who underwent curative intent resection for CRC were retrospectively studied. Of these patients, those who with 30 days postoperative mortality (n=23), incomplete medical record (n=32), synchronous liver metastasis (n=148) and UICC stage IV (n=54) were excluded, and finally 1,099 patients were analyzed, including 977 patients without liver metastasis and 122 patients with MLM-only. Clinical and pathological records for each patient were reviewed from medical charts. The clinicopathologic characteristics of 1,099 patients were investigated. RESULTS: The median timing of developing MLM was 13 months with a range of 4 to 79 months. Univariate analysis identified that preoperative serum carcinoembryonic antigen (CEA) level, depth of invasion, lymph nodes metastasis, vascular invasion, and perineural invasion were significantly correlated with the development of MLM (all P<0.05). Meanwhile, a multivariate analysis showed that preoperative serum carcinoembryonic antigen (CEA) level>5 ng/ml (Odds Ratio [OR]=1.591; 95% Confidence Interval [CI], 1.065-2.377; P=0.024), tumor depth (OR=2.294; 95% CI, 1.103-4.768; P=0.026), positive lymph node metastasis (OR=2.004; 95% CI, 1.324-3.031; P=0.001) and positive vascular invasion (OR=1.872; 95% CI, 1.225-2.861; P=0.004) were independent prognostic factors contributing to the occurrence of MLM. CONCLUSIONS: The present study demonstrates that preoperative serum CEA level, tumor depth, lymph node metastasis, and positive vascular invasion could affect the occurrence of MLM in CRC patients following curative resection, and thus could help to define these high-risk patients who would benefit from enhanced surveillance and therapeutic program(s).
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机译：背景：外科治疗后，在20-40％的大肠癌（CRC）患者中发生异时性肝转移（MLM）。本研究的目的是确定根治性切除后影响CRC患者MLM发展的危险因素。方法：回顾性研究了1,356例接受CRC根治性切除术的患者。在这些患者中，排除了术后30天死亡（n = 23），病历不完整（n = 32），同步肝转移（n = 148）和UICC IV期（n = 54）的患者，最终1,099名患者进行了分析，包括977例无肝转移的患者和122例仅有MLM的患者。从病历表中回顾了每位患者的临床和病理记录。研究了1,099例患者的临床病理特征。结果：发展传销的中位时间为13个月，范围为4到79个月。单因素分析表明，术前血清癌胚抗原（CEA）水平，浸润深度，淋巴结转移，血管浸润和神经周浸润与MLM的发生密切相关（所有P <0.05）。同时，多因素分析显示术前血清癌胚抗原（CEA）水平> 5 ng / ml（几率[OR] = 1.591; 95％置信区间[CI]，1.065-2.377; P = 0.024），肿瘤深度（OR） = 2.294; 95％CI，1.103-4.768; P = 0.026），阳性淋巴结转移（OR = 2.004; 95％CI，1.324-3.031; P = 0.001）和阳性血管侵犯（OR = 1.872; 95％CI， 1.225-2.861; P = 0.004）是导致MLM发生的独立预后因素。结论：本研究表明，术前血清CEA水平，肿瘤深度，淋巴结转移和积极的血管浸润可影响根治性切除术后CRC患者MLM的发生，从而有助于确定这些高危患者并从中受益来自增强的监视和治疗程序。
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