[Liver metastasis. Clinico-pathological prognostic factors in metastasis from colorectal cancer]

Hepatic Metastases (HM) from colorectal cancer represents one of the main problems of oncologic treatment: from 80 to 90 percent of patients undergo chemotherapy and a minority hepatic resection. The natural history of patients with unresectable HM has been recently investigated by uni and multivariate analyses; the percentage of hepatic replacement, the stage and grade of primary colorectal tumours, alkaline phosphatase and the presence of extrahepatic disease proved to be the most important independent prognostic factors. Albumin and carcino-embryonic antigen (CEA) levels, age and weight loss of patients were also prognostic. The groups of patients with more favourable factors had a median survival ranging from 21 to 35 months, in contrast to a median survival of 4 to 8 months for those with adverse factors. The outcome of more than 3400 patients submitted to hepatic resection, has been investigated. At multivariate analysis twelve variables resulted independently related to prognosis: stage of primary tumour, extent of liver involvement and presence of extrahepatic metastases were considered to be the most important. The knowledge of prognostic factors is extremely important in selecting patients candidated to various treatments, to interpret the results and to plan new therapeutic strategies.