Abstract
Purpose
We investigated the prognostic value of distant metastasis sites among patients with metastatic colorectal cancer (CRC) and the significance of metastasectomy and resection of the primary CRC.
Methods
Between 2010 and 2014, patients diagnosed with metastatic colorectal adenocarcinoma were selected using the surveillance, epidemiology, and end results (SEER) database. The prognosis of these patients was compared according to the site of metastasis (liver, lung, bone, and brain). A total of 15,133 patients suffered from isolated organ involvement, while 5135 patients experienced multiple organ metastases.
Results
In the isolated organ metastasis cohort, median overall survival (OS) for patients with liver, lung, bone, and brain metastases was 16, 20, 7, and 5 months, respectively. Patients with isolated lung metastases had better cancer-specific survival (CSS) and OS as compared to patients with metastases at any other sites (p < 0.0001 for both CSS and OS). Patients with isolated liver metastases had better prognosis as compared to patients with isolated bone or brain metastases (p < 0.0001 for both CSS and OS). Moreover, patients with a single metastatic site had better prognosis than patients with multiple organs involved (p < 0.0001 for both CSS and OS). Multivariate analysis in patients with isolated organ metastases demonstrated that age ≤ 60 years, rectal cancer, being married, non-black race, N0 stage, and surgery of the primary and distant lesions showed more favorable prognosis.
Conclusions
The metastatic site was an independent prognostic factor in stage IV colorectal cancer. Also, carefully chosen patients may benefit from surgery.
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Funding
This work was supported by the National Natural Science Foundation of China (Grant No. 81772599, No. 81702353) and Shanghai Municipal Natural Science Foundation (17ZR1406400).
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This study was approved by the Institutional Review Board of Fudan University Shanghai Cancer Center.
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The authors declare that they have no conflicts of interest.
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Supplementary Fig. 1
Kaplan-Meier curve of overall survival in patients with isolated liver or lung metastases who underwent surgical resection of both primary and metastatic lesions. (GIF 7 kb)
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Luo, D., Liu, Q., Yu, W. et al. Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study. Int J Colorectal Dis 33, 1241–1249 (2018). https://doi.org/10.1007/s00384-018-3091-x
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DOI: https://doi.org/10.1007/s00384-018-3091-x