Early recurrence predicts survival in patients with 10 or more bilobar colorectal liver metastases: A LASSO regression-based nomogram model
In brief
Early recurrence marks 31-month median survival, versus 53, after extensive liver surgery
In this retrospective study of 103 patients with at least 10 colorectal liver metastases, recurrence within 6 months occurred in about half and was linked to median survival of 31 months, versus 53 months without early recurrence. A preoperative model retained predictive ability in validation cohorts, but the small, single-center study needs broader testing; repeat curative treatment was linked to better survival after early recurrence.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 19 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Flavio Milana, Fabio Procopio, Giorgia Amy Rodda, Sabrina Caspani, Giacomo Ambrogi, Jacopo Galvanin, et al.
- PMID
- 42790261
- DOI
- 10.1016/j.ejso.2026.112119
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 29 September 2026): Early recurrence predicts survival in high‑burden colorectal liver metastases
Abstract
INTRODUCTION: Parenchymal-sparing one-stage hepatectomy (POSH) has expanded surgical eligibility for patients with high-burden (≥10) colorectal liver metastases (CLM). Early recurrence (ER), defined as recurrence within 6 months, remains a challenge, and its prognostic significance and preoperative predictability in this population are poorly defined. This study aimed to evaluate the long-term impact of ER, to develop and validate a preoperative predictive model, and to assess the feasibility of repeat curative treatment according to recurrence patterns. METHODS: Consecutive patients undergoing curative-intent POSH for ≥10 bilobar CLM at a single institution (2014-2023) were retrospectively analyzed. A LASSO-penalized preoperative nomogram was developed and internally validated (bootstrap), with additional external, temporal validation in an independent 2023-2025 cohort. Overall Survival (OS) and repeat hepatectomy feasibility were assessed. RESULTS: Among 103 patients, ER occurred in 51.5%. ER patients had significantly shorter median OS than non-ER patients (30.6 vs 53.4 months; p = 0.011), with ER remaining independently associated with OS on multivariate analysis (HR 2.18; p = 0.016). The preoperative nomogram demonstrated strong discrimination (C-index: 0.831), preserved at internal (C-index: 0.786) and temporal validation (C-index: 0.733). ER patients undergoing repeat curative treatment achieved 3-year OS comparable to late recurrence patients (72.0% vs 79.9%), whereas those who did not had dismal outcomes (17.1%; p < 0.001). CONCLUSIONS: In high-burden CLM, ER represents a biological marker of poor prognosis. The validated nomogram enables preoperative identification of high-risk patients, supporting intensified postoperative surveillance strategies. ER prompt detection is critical to facilitate repeat curative interventions, which remain the only pathway to prolonged survival.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.