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.

Patients with stage IV colorectal cancer live longer when tumors in their liver can be removed surgically, but not all patients have cancer that can be operated on.

Separating patients with liver tumors from colorectal cancer into three groups according to possible liver resectability, British doctors found a wide variation in both overall survival and progression-free survival three years later.

A team of surgeons, medical oncologists, and radiologists at the Royal Marsden Hospital in London divided patients in a clinical trial studying CAPOX chemotherapy into three groups:

• A — those whose treatment was considered to be palliative and not treatable with surgery.
• B — those where chemotherapy might convert initially unresectable metastases and make surgery possible.
• C — patients with resectable liver mets receiving neoadjuvant chemotherapy before surgery.

Among 128 patients who were part of the study, 74 were in the palliative group, 22 in the conversion, and 32 in the neoadjuvant groups.

Patients had scans every four  chemotherapy cycles, and when it was possible liver surgery was attempted after four or eight cycles.

• Ten patients (45 percent) of the conversion group and 19 (59 percent) of the neoadjuvant group eventually had surgery.
• Three years later, 10 percent of the conversion and 37 percent of the neoadjuvant group were alive and their cancer had not gotten worse (progression-free survival).

Median overall survival for all three groups:

• Palliative treatment — 14.6 months
• Conversion chemotherapy — 24.5 months
• Neoadjuvant chemo — 52.9 months

Patients in the study received CAPOX chemotherapy in three week cycles.  The CAPOX regimen was oral Xeloda® (capecitabine) daily for 14 days after an initial infusion of oxaliplatin on day one.

The team concluded,

This prospective study shows the wide variation in outcome according to baseline resectability status and highlights the potential clinical value of a modified staging system to distinguish between these patient subgroups.

SOURCE: Watkins et al., British Journal of Cancer, Volume 102, pp. 255-261, published online January 19, 2010.