Retrospective study of survival impact of local therapy for early recurrence after resection of colorectal liver metastases

Early recurrence following hepatectomy for colorectal liver metastases (CLM) is associated with worse survival. The survival impact of further local therapy (ablation, resection, or radiation) after recurrence is unclear. A retrospective analysis of a prospectively maintained database at MD Anderson Cancer Center (Houston, TX) found that of 671 patients undergoing hepatectomy (2001-2020) 541 recurred: 189 early (RFS < 6 months), 180 intermediate (RFS 6-12 months) and 172 later. Local therapy for recurrence resulted in improved survival: early 78 versus 32 months, intermediate 72 versus 39 months, and later 132 versus 65 months (all p<0.001). Following recurrence, local therapy (HR 0.24), liver and extrahepatic recurrence (HR 1.81), RAS + TP53 co-mutation (HR 1.52), and SMAD4 mutation (HR 1.92) were independently associated with survival (all p≤0.002). The authors conclude that while most patients recur after hepatectomy for CLM, local therapy may result in long-term survival despite early recurrence.