The natural history of liver metastases from colorectal cancer

The optimal treatment for patients with liver metastases from colorectal cancer is surgical resection. However, fewer than 10% of these patients will be amenable to this surgery. The aim of this study is to ascertain the natural history of a group of untreated patients, and to evaluate simultaneously in another group whether or not the administration of systemic chemotherapy modifies this natural history.

From January 1986 to September 1996, 77 patients with liver metastases from colorectal cancer biopsy proven or documented by means of a CT scan or a liver ultrasound were retrospectively analyzed. The group was divided according to treatment as follows: Group A, untreated patients, and Group B, those patients who received chemotherapy (5-FU 450 mg/m2/days 1-5 of the first week and thereafter weekly) + leucovorin 20 mg/m2 on the same days as 5-FU. The end points were patterns of recurrence and survival evaluated by means of the Mann-Whitney test and the Kaplan-Meier method.

There were 41 females and 36 males in the study. Their median age was 59 years (range, 30-80). The primary tumor was located in the rectum in 44, in the sigmoid, 20, cecum, 9, descending colon, 2, hepatic flexure, 1, and transverse colon, 1. Forty-nine patients had metachronous and 28 had synchronous liver metastases. In group A, which was made up of 45 patients, 41 developed extrahepatic metastatic disease, and their median survival rate was 13 months (range, 3-57). In group B, including 32 patients, 29 developed extrahepatic metastatic disease, and their median survival rate was 15 months (range, 4-60). There were no differences in overall survival in both groups (p = 1.00). All patients in both groups died of the metastatic disease.

The natural history of patients with liver metastases from colorectal cancer is towards progressive hepatic and extrahepatic metastatic disease. The administration of systemic chemotherapy did not modify the natural course of the disease.