A Real‐World, Population‐Based Analysis of the Outcomes of Colorectal Cancer Patients with Isolated Synchronous Liver or Lung Metastases Treated with Metastasectomy

Abstract

Objective To assess the survival outcomes among a contemporary cohort of colorectal cancer patients with isolated synchronous liver or lung metastases treated with or without surgical resection of the metastases. Methods Surveillance, epidemiology and end results database has been accessed and cases with isolated liver or lung metastases diagnosed 2010–2015 have been accessed. Kaplan–Meier survival estimates were used to compare overall survival among patients who had or had not undergone metastasectomy. Multivariable Cox regression analysis was then used to assess the impact of metastasectomy on colorectal cancer‐specific survival. Results A total of 16,372 patients with colorectal cancer with isolated liver or lung metastases (M1a disease) were included in the current analysis (including 14,832 patients with isolated liver metastases and 1540 patients with isolated lung metastases). Patients who had undergone surgical resection of liver metastases have better overall survival compared to patients who had not undergone surgical resection of liver metastases (median overall survival: 38.0 months vs. 13.0 months; P < 0.001). Likewise, patients who had undergone surgical resection of lung metastases have better overall survival compared to patients who had not undergone surgical resection of lung metastases (median overall survival: 45.0 months vs. 19.0 months; P < 0.001). In a multivariable Cox regression analysis and among patients with isolated liver metastases, surgery to the metastases was associated with a reduced hazard of death (hazard ratio (HR) 0.567; 95% CI 0.529–0.609; P < 0.001). Likewise, and among patients with isolated lung metastases, surgery to the metastases was associated with a reduced hazard of death (HR 0.482; 95% CI 0.349–0.665; P < 0.001). Conclusion In a contemporary cohort, metastasectomy seems to be associated with improvement in overall and cancer‐specific survival among patients with isolated synchronous liver or lung metastases from colorectal cancer. Whether this survival difference is totally ascribed to the effect of metastasectomy or it is the fact that patients who were eligible for surgical resection have limited disease extent and better medical profile (thus, leading to better survival) is unclear from such a population‐based study.

Real-World Outcomes in Patients with Metastatic Colorectal Cancer in Spain: The RWD-ACROSS Study

“…In comparison, surgical resection-of either the primary tumor or metastases-was more strongly predictive of both OS and PFS. A favorable association between metastasectomy and prolonged OS in mCRC has been described previously [31]. It is unclear whether this effect is due to the surgery itself or due to factors associated with surgical candidacy.…”

Clinicopathological factors associated with synchronous distant metastasis and prognosis of stage T1 colorectal cancer patients

“…The tumor grades were grouped as: Grade I (well differentiated); Grade II (moderately differentiated); Grade III (poorly differentiated); Grade IV (undifferentiated or anaplastic lesions). The metastasectomy was de ned by ''non-primary surgical procedure to a distant site'' in the record of ''surgery other regional/distant (2003+)'' 40 . This study was based on public data from the SEER database, and it did not include interaction with human subjects or the use of personal identifying information.…”

Impact of perioperative chemotherapy on survival outcomes among patients with metastatic colorectal cancer to the liver

“…Because the majority of the intestinal mesenteric drainage enters the hepatic portal venous system, hepatic metastases develop in approximately half of all colorectal cancer cases with nearly one-fth to one-quarter of newly diagnosed metastatic colorectal cancer patients present with liver metastases at the time of primary diagnosis 2,4 . Surgical resection alone is the cornerstone of treatment for patients with liver metastases from colorectal cancer in whom there is at least a one in six chance of cure after hepatectomy and apparent clinical cure is achieved in those who survive 10 years [5][6][7] . In the past 15-20 years, Profound improvements in outcomes of metastatic CRC resulted in more than a doubling of the 5year survival 4,8,9 .…”