Impact of Site-Specific Metastases on Surgical Value and Survival among Metastatic Colorectal Cancer Patients

Abstract

We aimed to explore the potential prognostic impact of the metastatic site on the management approach and prognosis of stage IV colorectal cancer patients with synchronous metastases. Synchronous metastatic colorectal cancer patients reported to the Surveillance, Epidemiology, and End Results Program database between 2010 and 2013 were included in this study. Overall survival (OS) was compared between patients with different treatment options using risk-adjusted Cox proportional hazard regression models. Overall, 17,776 patients with stage IV colorectal cancer were identified. Of these patients, 2,052 (11.5%) underwent surgical resection for tumors at both the primary and meta-static sites. Patients who underwent surgical resection of both primary and metastatic sites with liver, lung, and simultaneous liver and lung metastases had a longer median OS ( P < 0.001) than patients who underwent nonsurgical treatments. Cox regression analysis revealed that surgical resection of both primary and metastatic sites was associated with a significantly enhanced OS ( P < 0.001). Colorectal cancer patients with hepatic or pulmonary metastases, who underwent metastasectomy, even in selected patients with both hepatic and pulmonary metastases after multidisciplinary evaluation, could have a better survival benefit than patients who underwent nonsurgical treatments.

Homogeneous and heterogeneous risk and prognostic factors for lung metastasis in colorectal cancer patients

“…In addition to the primary site, surgical treatment is another heterogeneous factor. Patients who underwent surgical resection of the primary tumour survived longer than those who did not [ 19 ]. Some studies have shown that resection of lung metastasis also has a positive effect on improving survival outcomes [ 20 – 23 ].…”

Does pulmonary metastasectomy of colorectal metastases translate to better survival? A systematic review

“…[2][3][4] Lee-Ying et al reported median OS of 42.8 months after LUM compared to 48.0 months after LIM (P=0.69). 12,14,15 Similarly, Iwasaki et al reported estimated 5-year OS of 37.0% after LUM vs 42.8% after LIM (P=0.46). 14 However, Zong et al reported better survival after LUM, with a median OS of 38 months (range 26.5-49.5) after LUM versus 30 months (range 28.0-32.0) after LIM.…”

“…The sample sizes in the studies were mostly small, with the exception of Zong et al who studied 1047 patients with CRC LUM. 12 With the exception of Iwasaki et al who published their study in 2005, the publication dates were more recent for the rest of the included sample, ranging from 2015 to 2020.…”

“…14 However, Zong et al reported better survival after LUM, with a median OS of 38 months (range 26.5-49.5) after LUM versus 30 months (range 28.0-32.0) after LIM. 12 LUM is associated with longer disease-free survival than LIM Only 1 study, Iwasaki et al, reported disease-free survival (DFS). When compared to LIM, LUM was associated with significantly longer median DFS (947.06±840.39 versus 246.03±229.26 days, P<0.01).…”

Surgical Metastasectomy in the Spine: A Review Article

“…Surgical metastasectomy (SM) has been performed more frequently for a series of cancer types in the recent decades despite the increasing efficacy of other modern systemic treatment modalities [1–5]. SM improves the overall survival and has become a standard treatment for pulmonary metastases in sarcoma [6] and colorectal liver metastases [7].…”