Advertisement

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 Li
  • Xinxiang Li
Original Article

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.

Keywords

Distant metastatic site Prognosis Colorectal cancer 

Notes

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)

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108.  https://doi.org/10.3322/caac.21262 CrossRefPubMedGoogle Scholar
  2. 2.
    Lee WS, Yun SH, Chun HK, Lee WY, Yun HR, Kim J, Kim K, Shim YM (2007) Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Color Dis 22(6):699–704.  https://doi.org/10.1007/s00384-006-0218-2 CrossRefGoogle Scholar
  3. 3.
    Yoo PS, Lopez-Soler RI, Longo WE, Cha CH (2006) Liver resection for metastatic colorectal cancer in the age of neoadjuvant chemotherapy and bevacizumab. Clin Colorectal Cancer 6(3):202–207.  https://doi.org/10.3816/CCC.2006.n.036 CrossRefPubMedGoogle Scholar
  4. 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. 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
  6. 6.
    Onesti JK, Mascarenhas CR, Chung MH, Davis AT (2011) Isolated metastasis of colon cancer to the scapula: is surgical resection warranted? World J Surg Oncol 9:137.  https://doi.org/10.1186/1477-7819-9-137 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kruser TJ, Chao ST, Elson P, Barnett GH, Vogelbaum MA, Angelov L, Weil RJ, Pelley R, Suh JH (2008) Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer 113(1):158–165.  https://doi.org/10.1002/cncr.23531 CrossRefPubMedGoogle Scholar
  8. 8.
    Van Cutsem E, Cervantes A, Nordlinger B, Arnold D, Group EGW (2014) Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii1–iii9.  https://doi.org/10.1093/annonc/mdu260 CrossRefPubMedGoogle Scholar
  9. 9.
    Singh S, Singh PP, Murad MH, Singh H, Samadder NJ (2014) Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol 109(9):1375–1389.  https://doi.org/10.1038/ajg.2014.171 CrossRefPubMedGoogle Scholar
  10. 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
  11. 11.
    Robinson JR, Newcomb PA, Hardikar S, Cohen SA, Phipps AI (2017) Stage IV colorectal cancer primary site and patterns of distant metastasis. Cancer Epidemiol 48:92–95.  https://doi.org/10.1016/j.canep.2017.04.003 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 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. 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. 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. 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
  16. 16.
    Katoh M, Unakami M, Hara M, Fukuchi S (1995) Bone metastasis from colorectal cancer in autopsy cases. J Gastroenterol 30(5):615–618CrossRefPubMedGoogle Scholar
  17. 17.
    Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2016) The characteristics of bone metastasis in patients with colorectal cancer: a long-term report from a single institution. World J Surg 40(4):982–986.  https://doi.org/10.1007/s00268-015-3296-x CrossRefPubMedGoogle Scholar
  18. 18.
    Schouten LJ, Rutten J, Huveneers HA, Twijnstra A (2002) Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 94(10):2698–2705CrossRefPubMedGoogle Scholar
  19. 19.
    Ko FC, Liu JM, Chen WS, Chiang JK, Lin TC, Lin JK (1999) Risk and patterns of brain metastases in colorectal cancer: 27-year experience. Dis Colon Rectum 42(11):1467–1471CrossRefPubMedGoogle Scholar
  20. 20.
    Noura S, Ohue M, Shingai T, Fujiwara A, Imada S, Sueda T, Yamada T, Fujiwara Y, Ohigashi H, Yano M, Ishikawa O (2012) Brain metastasis from colorectal cancer: prognostic factors and survival. J Surg Oncol 106(2):144–148.  https://doi.org/10.1002/jso.23055 CrossRefPubMedGoogle Scholar
  21. 21.
    Chien C, Morimoto LM, Tom J, Li CI (2005) Differences in colorectal carcinoma stage and survival by race and ethnicity. Cancer 104(3):629–639.  https://doi.org/10.1002/cncr.21204 CrossRefPubMedGoogle Scholar
  22. 22.
    Li Q, Gan L, Liang L, Li X, Cai S (2015) The influence of marital status on stage at diagnosis and survival of patients with colorectal cancer. Oncotarget 6(9):7339–7347.  https://doi.org/10.18632/oncotarget.3129 PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Inra JA, Syngal S (2015) Colorectal cancer in young adults. Dig Dis Sci 60(3):722–733.  https://doi.org/10.1007/s10620-014-3464-0 CrossRefPubMedGoogle Scholar
  24. 24.
    Suttie SA, Shaikh I, Mullen R, Amin AI, Daniel T, Yalamarthi S (2011) Outcome of right- and left-sided colonic and rectal cancer following surgical resection. Color Dis 13(8):884–889.  https://doi.org/10.1111/j.1463-1318.2010.02356.x CrossRefGoogle Scholar
  25. 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. 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
  27. 27.
    Yoon YS, Kim CW, Lim SB, Yu CS, Kim SY, Kim TW, Kim MJ, Kim JC (2014) Palliative surgery in patients with unresectable colorectal liver metastases: a propensity score matching analysis. J Surg Oncol 109(3):239–244.  https://doi.org/10.1002/jso.23480 CrossRefPubMedGoogle Scholar
  28. 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

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

Personalised recommendations