Young Patients Do Worse After Surgery for Liver Mets

Patients under 40 appear to have more aggressive liver tumors from colorectal cancer and poorer long-term outcomes.

After surgery to remove the cancer that had spread to their liver, patients who were 40 or younger had poorer overall survival and shorter time until cancer returned.

The percentage of younger patients who were alive without cancer five years later was similar to older patients, which the research team attributed to more aggressive treatment for the young patients, along with repeated surgery. 

All patients who had surgery to remove colorectal cancer that had spread to their livers (liver resection) at the French Hôpital Paul Brousse from 1990 through 2006 were studied.  56 of 806 (7 percent) were 40 years old or younger.

They had more liver metastases when they were diagnosed  than older patients, and liver tumors were more often found at the same time as their primary tumor in colon or rectum.

Comparing younger and older patients:

  • Half of older patients (51 percent) were alive at five years (overall survival) compared to a third (33 percent) of the younger ones.
  • Only 2 percent of  young patients didn’t have cancer get worse during the five years after surgery (progression-free survival) compared to 16 percent of older ones.
  • Disease-free survival at five years was similar in both groups (17 percent for young, 23 percent for older.)
  • Being 40 or younger independently predicted poor progression-free survival.

Robbert J. de Haas, MD and his colleagues concluded,

In young patients, colorectal liver metastases seem to be more aggressive, with a trend toward lower overall survival, more disease recurrences, and a significantly shorter progression-free survival after hepatectomy. However, disease-free survival rates were comparable between young and older patients, owing to an aggressive multimodality treatment approach, consisting of chemotherapy and repeat surgery. Therefore, physicians should recognize the poor outcome of colorectal liver metastases in young patients and should consider an aggressive approach to diagnosis and early treatment.

SOURCE: de Haas et al., Cancer, Volume 115, Issue 3, Pages 647 – 658, February 1, 2010.

Comments

  1. Jennifer says

    Treatment protocols changed a lot between 1990 and 2006. Is there any hint from this or other research that younger patients are doing better now?

  2. Kate Murphy says

    Survival statistics for both young and older patients have improved significantly over the years as treatment with surgery and chemotherapy have become more effective.

    These statistics take a long view in suggesting that colorectal cancer that has spread to the liver may be more aggressive in patients 40 and younger and that treatment should likewise be aggressive, combining chemotherapy with surgery and doing additional surgeries, if possible.

    The statistics cover a long period of time and probably do not apply to a patient — either young or old — diagnosed today.

  3. Kate Murphy says

    Colorectal cancer is very rare in people under the age of 20.

    US statistics show about 7 cases in 10 million young people under 20.

    This compares to nearly 15,000 cases in 10 million adults over 50 and 600 cases per 10 million in those under 50.

    However, anyone with symptoms of colorectal cancer should see a doctor for an evaluation of what might be wrong at any age.

  4. Tina Bruce says

    What are the guide lines that determine if a patient is eligable for a liver resection? I know it depends on how many lesions they have but what are the other factors?

  5. Kate Murphy says

    Surgeons don’t look so much at the number of lesions any longer, but the amount of healthy “remnant” liver that would remain after all tumor was removed. The general rule is that at least 30 percent of healthy liver will be there to regenerate.

    The liver is a remarkable organ in that it can replace itself.

    Other factors that are considered include location of lesions — tumors close to important blood vessels can rule out a resection.

    If there are other metastatic tumors outside the liver (extra-hepatic) most surgeons will not want to operate on the liver unless those tumors can also be removed surgically.

    The goal is not to expose a patient to a painful, potentially risky surgery which will not improve survival. Further, preparing for and recovering from surgery limits the chance to use chemotherapy.

    An experienced liver surgeon is the best person to answer questions about surgical possibilities for an individual.

    In the past 5 to 10 years, many of the older “rules” about surgery to remove liver mets have been changed and more potentially curable liver surgery is being done.

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