Liver-Directed Surgery for Metastatic Squamous Cell Carcinoma to the Liver: Results of a Multi-Center Analysis

Authors: Pawlik, Timothy¹; Gleisner, Ana²; Bauer, Todd³; Adams, Reid³; Reddy, Srinevas⁴; Clary, Bryan⁴; Martin, Robert⁵; Scoggins, Charles⁵; Tanabe, Kenneth⁶; Michaelson, James⁶; Kooby, David⁷; Staley, Charles⁷; Schulick, Richard²; Vauthey, Jean-Nicolas⁸; Abdalla, Eddie⁸; Curley, Steven⁸; Choti, Michael²; Elias, Dominque⁹

Source: Annals of Surgical Oncology, Volume 14, Number 10, October 2007 , pp. 2807-2816(10)

Publisher: Springer

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Abstract:

The role of hepatic resection for metastatic squamous cell carcinoma (SCC) remains unknown. The current study evaluates the role of hepatic resection in patients with metastatic SCC to the liver.

Between 1988 and 2006, 52 patients underwent hepatic resection of metastatic SCC at eight major cancer centers. Clinicopathologic factors were analyzed with regard to disease-free survival (DFS) and overall survival (OS).

Primary SCC site was anal (n = 27), head/neck (n = 12), lung (n = 4), esophagus (n = 2), and other (n = 7). Treatment of primary SCC was chemotherapy ± radiotherapy alone (n = 29), chemotherapy ± radiotherapy + surgery (n = 15), or surgery alone (n = 8). Forty-seven patients underwent resection alone, 2 resection + radiofrequency ablation (RFA), and 3 RFA only. At last follow-up, 33 (63.5%) patients had recurred. The median time to recurrence was 9.8 months, and 5-year DFS was 18.6%. Factors associated with reduced DFS were liver tumor size > 5 cm (hazard ratio (HR) = 2.02) and positive surgical margin (HR = 2.33). The overall median survival after hepatic resection was 22.3 months and 5-year actuarial OS was 20.5%. Risk factors associated with worse overall survival included synchronous disease (HR = 4.09), hepatic metastasis > 5 cm (HR = 1.71) and positive surgical resection margin (HR = 1.83).

The majority of patients will recur following hepatic resection of SCC. Long-term survival, however, can be achieved following surgical resection of SCC liver metastasis, especially in patients who present with limited metachronous disease amenable to margin negative resection.

Keywords: Squamous cell carcinoma; Hepatic resection; Prognosis

Document Type: Research article

DOI: 10.1245/s10434-007-9467-8

Affiliations: 1: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA, Email: tpawlik1@jhmi.edu 2: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA 3: Department of Surgery, University of Virginia Medical Center, Charlottesville, VA, USA 4: Department of Surgery, Duke University Medical Center, Durham, NC, USA 5: Department of Surgery, University of Louisville Medical Center, Louisville, KY, USA 6: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA 7: Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA 8: Department of Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA 9: Department of Surgery, Institute Gustave Roussy, Villejuif, France

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