Review
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World J Gastrointest Oncol. Dec 15, 2013; 5(12): 207-221
Published online Dec 15, 2013. doi: 10.4251/wjgo.v5.i12.207
Surgery for colorectal liver metastases: The evolution of determining prognosis
Gaya Spolverato, Aslam Ejaz, Nilo Azad, Timothy M Pawlik
Gaya Spolverato, Aslam Ejaz, Timothy M Pawlik, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
Nilo Azad, Department of Medical Oncology, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
Author contributions: All authors contributed to concept, design, data collection, drafting and critical revision of manuscript, and final approval of manuscript.
Correspondence to: Timothy M Pawlik, MD, MPH, PhD, FACS, Professor, Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, United States. tpawlik1@jhmi.edu
Telephone: +1-410-5022387 Fax: +1-410-5022388
Received: October 11, 2013
Revised: November 5, 2013
Accepted: November 15, 2013
Published online: December 15, 2013
Abstract

Despite improvements in the multi-modality treatment of colorectal liver metastasis (CRLM), survival after resection remains varied. Determining prognosis after surgical resection has historically been predicated on preoperative clinicopathological factors such as primary tumor stage, carcinoembryonic antigen levels, number of liver metastases, presence of extrahepatic disease, as well as other factors. While scoring systems have been developed by combining certain preoperative factors, these have been inconsistent in accurately determining prognosis. There has been increasing interest in the use of biologic and molecular markers to predict prognosis following CRLM. The role of markers such as KRAS, BRAF, p53, human telomerase reverse transcriptase, thymidylate synthase, Ki-67, and hypoxia inducible factor-1α and their correlation with accurately predicting survival after surgical resection have been supported by several studies. Furthermore, other elements such as pathological response to chemotherapy and the presence of circulating tumor cells have shown promise in accurately determining prognosis after resection for colorectal liver metastasis. We herein review past, present, and possible future markers of prognosis among colorectal cancer patients with liver metastasis undergoing resection with curative intent.

Keywords: Colorectal, Metastasis, Prognosis, Risk score, Molecular markers, Outcomes

Core tip: Historically, prognosis after resection has been largely assessed based on preoperative clinicopathologic features. Data validating the prognostic value of patient and tumor specific factors have been mixed, with many recent studies showing these scoring systems to correlate poorly with survival. Rather, there has been an emerging interest in biological or molecular markers of prognosis to more effectively assess patient prognosis after resection of colorectal liver metastasis. In this review, we discuss past, present, and possible future markers of prognosis among colorectal cancer patients with liver metastasis undergoing resection with curative intent.