Survival of hepatectomy in colorectal cancer patients with ten or more liver metastases: a retrospective cohort study of multidisciplinary treatment.

Background: Palliative chemotherapy is the standard first treatment for patients with ≥10 liver metastases, irrespective of resectability. This study aimed to assess the clinical benefits of hepatic resection and identify optimal treatments for colorectal cancer patients with ≥10 liver-limited metastases (LLMs).

Methods: A retrospective study of 373 patients with unresectable colorectal cancer and ≥10 liver metastases. Patients were grouped into hepatic surgery ± radiofrequency ablation (RFA) + systemic therapy, RFA + systemic therapy, and systemic therapy alone. Kaplan-Meier and Cox proportional hazards methods were used to analyze overall survival (OS) and progression-free survival (PFS). A nomogram was developed and validated.

Results: Three-year survival rates were 39.2%, 18.6%, and 8.2% for surgery ± RFA + systemic, RFA + systemic, and systemic only groups, respectively. Significant survival differences were noted in both KRAS/NRAS/BRAF wildtype and mutated cohorts. For wildtype LLMs, OS and PFS were 39.3 and 13.8 months for surgery ± RFA + systemic, compared to 23.9 and 9.9 months for RFA + systemic. The nomogram (C-index =0.709) identified independent prognostic factors for OS.

Conclusions: Hepatectomy, with or without RFA, is associated with significantly improved survival in selected patients with ≥10 liver metastases. Further prospective studies are needed to confirm these findings.