Histopathological growth patterns determines the outcomes of colorectal cancer liver metastasis that have undergone liver resection

Abstract

Abstract Introduction: Colorectal cancer liver metastasis (CRCLM) remains a lethal diagnosis with an overall 5-year survival rate of 5–10%. Two distinct histopathological growth patterns (HGPs) of CRCLM are known to have significantly differing rates of patients survival, and response to treatment. We set out to review the results of 275 patients who underwent liver resection for CRCLM at the McGill University Health Center (MUHC) and analyze their clinical outcome, mutational burden and pattern of cancer progression in light of their HGP’s, and to consider their potential effect on surgical decision making. Methods We performed a retrospective multivariate analysis on clinical data from patients with CRCLM (n = 275) who underwent liver resection at the McGill University Health Center (MUHC). All tumors were scored using international consensus guidelines by pathologists trained in HGP scoring. Results 109 patients (42.2%) were classified as desmoplastic and angiogenic whereas 149 patients (57.7%) were non-desmoplastic and vessel co-opting. The 5 year survival rates for angiogenic patients compared to vessel co-opting patients was 47.1% and 13% respectively (p < 0.0001). Multivariate analysis showed patients with vessel co-opting CRCLM had a higher incidence of extrahepatic metastatic disease (p = 0.0215) compared to angiogenic CRCLM. Additionally, KRAS mutation status was a marker of increased likelihood of disease recurrence (p = 0.0434) as was increased number of liver tumors (p = 0.0071) and multiple sites of extrahepatic metastatic disease (p < 0.0001). Conclusions Multivariate analysis identified key clinical prognostic and molecular features correlating to the two HGPs. Determining liver tumor HGPs is essential for patient prognostication and treatment optimization.