Recurrence patterns stratify post-progression survival after early recurrence of colorectal liver metastases following hepatectomy: a single-center retrospective study

Early recurrence of colorectal liver metastases (CRLM) after hepatectomy is generally considered high-risk; however, the prognosis may differ depending on whether recurrence is confined to a single site or involves multiple sites. This study evaluated post-progression survival (PPS) according to recurrence pattern at first relapse in patients with early recurrence.

We retrospectively reviewed consecutive patients who underwent initial curative-intent hepatectomy for CRLM at Chiba University Hospital between 2012 and 2022. Patients with recurrence within 12 months were classified as having single-site or multi-site recurrence at first relapse based on the number of involved organs or anatomically distinct compartments. PPS was calculated from the time of first recurrence and analyzed using Kaplan-Meier and Cox regression methods. Post-recurrence treatments, including salvage metastasectomy, were recorded.

Among 151 patients, 78 (51.7%) developed recurrence within 12 months: 43 with single-site and 35 with multi-site recurrence at first relapse. PPS was significantly longer in the single-site group than in the multi-site group (log-rank p = 0.016); median PPS was not reached in the single-site group and was 31 months in the multi-site group. On multivariable analysis, multi-site recurrence remained independently associated with poorer PPS (hazard ratio: 1.96, 95% confidence interval: 1.04-3.71; p = 0.037). Salvage metastasectomy was performed in 35 patients (44.9%); the proportion was comparable between the single-site and multi-site groups (46.5% vs. 42.9%, respectively; p = 0.821).

Among patients with early recurrence after hepatectomy for CRLM, the anatomical extent of the first relapse further stratified PPS. Multi-site recurrence was independently associated with poorer PPS, suggesting that early recurrence is not a single prognostic entity but comprises clinically heterogeneous subgroups.