Abstract:
BACKGROUND : Approximately 25% of patients with colorectal cancer (CRC) will be diagnosed with CRC liver metastases
(CRCLM) during the course of their disease. No data regarding CRCLM presentation, management and survival outcomes
has been published from either the private or public health care sectors in South Africa. This study aimed to address this
deficit, reporting on a private sector cohort.
METHODS : A retrospective review of a private health care funder’s database from 1 January 2008 to 31 December 2015
was performed. ICD-10 diagnosis codes were used to identify CRC and CRCLM. Procedure codes assigned to hospital
admissions were used to identify the type of surgical treatment. Chemotherapy was identified by the WHO Anatomical
Therapeutic Chemical classification system of medicines. Treatment patterns were assessed and five-year overall survival
(OS) was calculated. Survival was estimated using the Kaplan–Meier method, and Cox proportional-hazards regression
was used for between group survival comparisons.
RESULTS : Six hundred and one (601) of 3 412 patients presenting with CRC (17.6%) were diagnosed with CRCLM at
presentation or during the follow-up period. Sixty patients with CRCLM (10.0%) underwent resection of the primary
CRC and liver resection for metastases, 281 (46.8%) underwent CRC resection only, 180 (30%) received chemotherapy
only, and 47 (7.8%) received no treatment. Five-year OS for these groups were 57.3%, 15.6%, 9.8% and 0% respectively.
CONCLUSION : Five-year OS of the various CRCLM treatment pathways in a South African private sector population
compares to results published in international series. However, a smaller proportion of patients with CRCLM underwent
liver resection, compared to international studies
