Cause of death from liver metastases in colorectal cancer

Surgically directed therapy for liver metastases from colorectal cancer (CRC) has received substantial attention in the literature as a major focus of treatment for metastatic CRC. It is presumed, but not proven, that liver metastases are a major threat to life. This study examined the course of a cohort of consecutive patients who died with CRC to determine the role played by the presence of liver metastases.

This is single-institution retrospective observational study involved all patients who died of CRC. Records were examined and imaging studies reviewed to determine the extent of liver and extrahepatic metastases in these patients. Overall survival in patients with and without liver metastases and those in whom liver metastases were thought to contribute to death was determined.

After patient exclusions, the study population totaled 121 patients. There were 75 patients (62%) with liver metastases at death. In 40 of 75 (53%) patients, the liver metastases contributed to the patients' death. In 46 of 121 patients (38%), metastatic disease did not include liver metastases. Overall survival in patients with and without liver metastases (median survival 12 vs. 8.5 months, p = 0.089) and in those whose liver metastases did or did not contribute to death (median survival 11.5 vs. 14 months, p = 0.361) was not significant.

The presence of liver metastases seemed to contribute to death in approximately half of the study patients, although there did not appear to be a survival disadvantage in these patients.