Histopathological prognostic factors for colorectal liver metastases.: A systematic review and meta-analysis of observational studies

• Cássio Virgílio Cavalcante de Oliveira ^[1] ; Gilton Marques Fonseca ^[1] ; Jaime Arthur Pirola Kruger ^[1] ; Evandro Sobroza de Mello ^[1] ; Fabricio Ferreira Coelho ^[1] ; Paulo Herman ^[1]
  1. [1] Universidade de São Paulo

     Universidade de São Paulo

     Brasil

     
• Localización: Histology and histopathology: cellular and molecular biology, ISSN-e 1699-5848, ISSN 0213-3911, Vol. 36, Nº. 2, 2021, págs. 159-181
• Idioma: inglés
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• Resumen

  • Introduction. Resection is the mainstay of treatment for colorectal liver metastases (CRLMs).

    Many different histopathological factors related to the primary colorectal tumour have been well studied;

    however, histopathological prognostic factors related to CRLMs are still under evaluation. Objective. To identify histopathological factors related to overall survival (OS) and disease-free survival (DFS) in patients with resected CRLMs.

    Methods. A systematic review was performed with the following databases up to August 2020: PubMed, EMBASE, Web of Science, SciELO, and LILACS. The GRADE approach was used to rate the overall certainty of evidence by outcome.

    Results. Thirty-three studies including 4,641 patients were eligible. We found very low certainty evidence that the following histopathological prognostic factors are associated with a statistically significant decrease in OS:

    presence of portal vein invasion (HR, 410.50 [95% CI, 0.37 to 0.68]; I2=0%), presence of perineural invasion (HR, 0.55 [95% CI, 420.36 to 0.83]; I2=0%), absence of pseudocapsule (HR, 0.41 [CI 95%, 0.29 to 0.57], p<0.00001; I2=0%), presence of satellite nodules (OR, 0.45 [95% CI, 0.26 to 0.80]; I2=0%), and the absence of peritumoural inflammatory infiltrate (OR, 0.20 [95% CI, 0.08 to 0.54]; I2=0%). Outcome data on DFS were scarce, except for tumour borders, which did not present a significant impact, precluding the meta-analysis.

    Conclusion. Of the histopathological prognostic factors studied, low- to moderate-certainty evidence shows that vascular invasion, perineural invasion, absence of pseudocapsule, presence of satellite nodules, and absence of peritumoral inflammatory infiltrate are associated with shorter overall survival in CRLMs