International Journal of Colorectal Disease

, Volume 33, Issue 9, pp 1241–1249 | Cite as

Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study

  • Dakui Luo
  • Qi Liu
  • Wencheng Yu
  • Yanlei Ma
  • Ji Zhu
  • Peng Lian
  • Sanjun Cai
  • Qingguo LiEmail author
  • Xinxiang LiEmail author
Original Article



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.


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.


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.


The metastatic site was an independent prognostic factor in stage IV colorectal cancer. Also, carefully chosen patients may benefit from surgery.


Distant metastatic site Prognosis Colorectal cancer 


Funding information

This work was supported by the National Natural Science Foundation of China (Grant No. 81772599, No. 81702353) and Shanghai Municipal Natural Science Foundation (17ZR1406400).

Compliance with ethical standards

This study was approved by the Institutional Review Board of Fudan University Shanghai Cancer Center.

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

384_2018_3091_Fig5_ESM.png (174 kb)
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)

384_2018_3091_MOESM1_ESM.tif (11 mb)
High Resolution Image (TIF 11301 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
  3. 3.Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina

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