Prognostic Preoperative Factors in Surgical Patients with Colorectal Liver Metastases: A Nationwide Multicenter Study

Purpose: Colorectal cancer is a leading cause of cancer-associated death. Metastatic disease in the liver is common and is associated with severely diminished survival rates. Despite various treatment modalities, comprehensive long-term survival data following surgical interventions for colorectal liver metastases (CRLM) is limited. Methods: This nationwide multicenter study used data from the Danish Liver Cancer Group registry. Patients undergoing initial surgery, including hepatic resection, ablation, or both, were included. Survival analysis was conducted using the Kaplan-Meier estimator and Cox proportional hazards models to evaluate the prognostic impact of clinical preoperative factors. Multiple imputation was performed for missing values. Results: Among 2316 patients, median survival was four years, with 1-, 3-, 5-, and 7-year survival rates of 91%, 61%, 42%, and 32%, respectively. Advancing age per year, higher performance status, metastases exceeding 3 cm, and an increasing number of metastases significantly increased mortality risks. Multivariable analysis further refined the hazard ratios (HR) for age per year (HR 1.02), WHO performance status ≥ 2 (HR 1.50), diameter of largest metastasis in cm (HR 1.19) and number of metastases ≥ 3 (HR 1.51). Conclusion: This study highlights the importance of considering age, performance status, and tumor burden in the preoperative evaluation to improve clinical outcomes.