{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T06:10:51Z","timestamp":1793513451884,"version":"4.5.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conventional survival analyses cannot fully account for recurrence as an intermediate event that dynamically influences subsequent mortality. Multistate models (MSMs) enable explicit modeling of transitions between clinically relevant disease states; however, their application among patients undergoing resection for colorectal liver metastases (CRLM) remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An international multi-institutional database was queried to identify patients undergoing curative-intent hepatectomy for CRLM between 1998 and 2023. A four-state MSM was constructed comprising alive and recurrence-free, alive with recurrence, colorectal cancer (CRC)-related death, and non-CRC-related death. Transition probabilities and transition-specific prognostic factors were evaluated<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 3002 patients, 1624 (54.1%) developed recurrence and 911 (56.1%) died, predominantly from CRC-related causes (92.8%). The probability of recurrence decreased substantially the longer patients remained recurrence-free after surgery, whereas recurrence markedly worsened subsequent prognosis. High tumor burden score was independently associated with transition to recurrence (hazard ratio [HR] 1.06 per unit; 95% confidence interval 1.03\u20131.08;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) but not post-recurrence mortality, suggesting that the adverse prognostic impact of tumor burden was mediated primarily through recurrence. Adjuvant chemotherapy reduced recurrence (HR 0.76;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and CRC-related death from the recurrence-free state (HR 0.39;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MSMs provide a dynamic framework to characterize disease evolution after CRLM resection and represent recurrence as a clinically meaningful time-dependent intermediate state rather than a simple binary endpoint. Recurrence was the dominant determinant of long-term prognosis, supporting the role of MSMs for individualized prognostication and surveillance after hepatectomy for CRLM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-20765-3","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:59:08Z","timestamp":1791925148000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Recurrence After Resection of\u00a0Colorectal Liver Metastases and Its Impact on Survival: A Multistate Model-Based, Multi-institutional Observational Cohort Study"],"prefix":"10.1245","author":[{"given":"Andrea","family":"Baldo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Akabane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalampos M.","family":"Charalampous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Elemosho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Kawashima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaya","family":"Spolverato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ruzzenente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Poultsides","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunari","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itaru","family":"Endo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Kitago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Aucejo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irinel","family":"Popescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Hugh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7994-9870","authenticated-orcid":false,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"3","key":"20765_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. 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