Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study
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.
KeywordsDistant metastatic site Prognosis Colorectal cancer
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.
- 4.Kemeny N (2006) Management of liver metastases from colorectal cancer. Oncology (Williston Park) 20(10):1161–1176 1179; discussion 1179-1180, 1185-1166Google Scholar
- 5.Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, Kameoka S, Saito Y, Takahashi K, Hase K, Oya M, Maeda K, Hirai T, Kameyama M, Shirouzu K, Muto T (2007) Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery 141(1):67–75. https://doi.org/10.1016/j.surg.2006.07.020 CrossRefPubMedGoogle Scholar
- 10.Van Cutsem E, Nordlinger B, Adam R, Kohne CH, Pozzo C, Poston G, Ychou M, Rougier P, European Colorectal Metastases Treatment G (2006) Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer 42(14):2212–2221. https://doi.org/10.1016/j.ejca.2006.04.012 CrossRefPubMedGoogle Scholar
- 12.Dong F, Shen Y, Gao F, Xu T, Wang X, Zhang X, Zhong S, Zhang M, Chen S, Shen Z (2017) Prognostic value of site-specific metastases and therapeutic roles of surgery for patients with metastatic bladder cancer: a population-based study. Cancer Manag Res 9:611–626. https://doi.org/10.2147/CMAR.S148856 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Miyoshi N, Ohue M, Shingai T, Noura S, Sugimura K, Akita H, Gotoh K, Motoori M, Takahashi H, Kishi K, Okami J, Marubashi S, Fujiwara Y, Higashiyama M, Yano M (2015) Clinicopathological characteristics and prognosis of stage IV colorectal cancer. Mol Clin Oncol 3(5):1093–1098. https://doi.org/10.3892/mco.2015.598 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Khattak MA, Martin HL, Beeke C, Price T, Carruthers S, Kim S, Padbury R, Karapetis CS (2012) Survival differences in patients with metastatic colorectal cancer and with single site metastatic disease at initial presentation: results from South Australian clinical registry for advanced colorectal cancer. Clin Colorectal Cancer 11(4):247–254. https://doi.org/10.1016/j.clcc.2012.06.004 CrossRefPubMedGoogle Scholar
- 15.Tie J, Lipton L, Desai J, Gibbs P, Jorissen RN, Christie M, Drummond KJ, Thomson BN, Usatoff V, Evans PM, Pick AW, Knight S, Carne PW, Berry R, Polglase A, McMurrick P, Zhao Q, Busam D, Strausberg RL, Domingo E, Tomlinson IP, Midgley R, Kerr D, Sieber OM (2011) KRAS mutation is associated with lung metastasis in patients with curatively resected colorectal cancer. Clin Cancer Res 17(5):1122–1130. https://doi.org/10.1158/1078-0432.CCR-10-1720 CrossRefPubMedGoogle Scholar
- 25.Oweira H, Petrausch U, Helbling D, Schmidt J, Mannhart M, Mehrabi A, Schob O, Giryes A, Decker M, Abdel-Rahman O (2017) Prognostic value of site-specific metastases in pancreatic adenocarcinoma: a surveillance epidemiology and end results database analysis. World J Gastroenterol 23(10):1872–1880. https://doi.org/10.3748/wjg.v23.i10.1872 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Kanas GP, Taylor A, Primrose JN, Langeberg WJ, Kelsh MA, Mowat FS, Alexander DD, Choti MA, Poston G (2012) Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol 4:283–301. https://doi.org/10.2147/CLEP.S34285 PubMedPubMedCentralCrossRefGoogle Scholar
- 28.Pulitano C, Bodingbauer M, Aldrighetti L, de Jong MC, Castillo F, Schulick RD, Parks RW, Choti MA, Wigmore SJ, Gruenberger T, Pawlik TM (2011) Liver resection for colorectal metastases in presence of extrahepatic disease: results from an international multi-institutional analysis. Ann Surg Oncol 18(5):1380–1388. https://doi.org/10.1245/s10434-010-1459-4 CrossRefPubMedGoogle Scholar