Echogenicity of liver metastases from colorectal carcinoma is an independent prognostic factor in patients treated with regional chemotherapy

BACKGROUND Echogenicity of liver metastases was found to be a predictive biologic factor influencing long‐term outcome after curative liver resection. The current analysis focuses on the influence of echogenicity on survival in patients treated with intraarterial chemotherapy for unresectable colorectal carcinoma liver metastases. METHODS A retrospective analysis of prospectively collected data at the Department of Surgery at the University of New South Wales‐affiliated St. George Hospital was performed. Two hundred twelve consecutive patients with unresectable hepatic metastases from colorectal carcinoma treated between May 1992 and September 2000 were analyzed. Echogenicity of metastases was measured intraoperatively using a 5 MHz probe. Overall survival difference was compared between hyper‐ and hypoechoic metastases on an intention‐to‐treat basis. RESULTS At a median followup of 15.1 months, 47 patients (22%) were alive and 165 (78%) had died. A significant survival benefit was observed in patients having hyperechoic lesions (median survival 16.2 months, 95% confidence interval [CI] 13.9–18.5) compared to hypoechoic lesions (median survival 11.6 months, 95% CI 8–15.2), P < 0.01. Other prognostic factors were differentiation of the primary tumor (P < 0.02), percentage hepatic replacement (P < 0.05) and carcinoembryonic antigen decrease (P < 0.03). Echogenicity was identified as an independent prognostic factor in multivariate analysis (P < 0.009). CONCLUSIONS Echogenicity is an important prognostic survival parameter. Cancer 2002;94:1753–9. © 2002 American Cancer Society. DOI 10.1002/cncr.10386 The effect of the echogenic appearance of unresectable colorectal liver metastases on overall survival in patients treated with regional chemotherapy was evaluated. Ultrasonic echogenicity was found to be highly prognostic for survival in this patient group.