Incidence and management of patients with colorectal cancer and synchronous and metachronous colorectal metastases: a population-based study

Abstract

Background: This population-based study aimed to examine the incidence, patterns and results of multimodal management of metastatic colorectal cancer. Methods: A retrospective population-based study was conducted on patients with metastatic colorectal cancer in Central Finland in 2000-2015. Clinical and histopathological data were retrieved and descriptive analysis was conducted to determine the pattern of metastatic disease, defined as synchronous, early metachronous (within 12 months of diagnosis of primary disease) and late metachronous (more than 12 months after diagnosis). Subgroups were compared for resection and overall survival (OS) rates. Results: Of 1671 patients, 296 (17⋅7 per cent) had synchronous metastases, and 255 (19⋅6 per cent) of 1302 patients with resected stage I-III tumours developed metachronous metastases (94 early and 161 late metastases). Liver, pulmonary and intraperitoneal metastases were the most common sites. The commonest metastatic patterns were a combination of liver and lung metastases. The overall metastasectomy rate for patients with synchronous metastases was 16⋅2 per cent; in this subgroup, 3and 5-year OS rates after any resection were 63 and 44 per cent respectively, compared with 7⋅1 and 3⋅3 per cent following no resection (P < 0⋅001). The resection rate was higher for late than for early metachronous disease (28⋅0 versus 17 per cent respectively; P = 0⋅048). Three-and 5-year OS rates after any resection of metachronous metastases were 78 and 62 per cent respectively versus 42⋅1 and 18⋅2 per cent with no metastasectomy (P < 0⋅001). Similarly, 3-and 5-year OS rates after any metastasectomy for early metachronous metastases were 57 and 50 per cent versus 84 and 66 per cent for late metachronous metastases (P = 0⋅293). Conclusion: The proportion of patients with metastatic colorectal cancer was consistent with that in earlier population-based studies, as were resection rates for liver and lung metastases and survival after resection. Differentiation between synchronous, early and late metachronous metastases can improve assessment of resectability and survival.

Immune Contexture of MMR-Proficient Primary Colorectal Cancer and Matched Liver and Lung Metastases

“…Of 1302 resected Stage I-III patients, 255 (19.6%) developed metachronous metastases. The overall metastasectomy rate was 16.2% with synchronous metastases and 23.9% with metachronous metastases [ 6 ]. Our study material included 113 CRC patients with operable liver and/or lung metastases operated at the Central Finland Central Hospital (CFCH) in Jyväskylä during the years 2000–2018.…”

“…The most common metastatic sites of CRC are the liver and lungs [ 3 , 4 ]. Approximately 15–25% of CRC patients have liver metastases at the time of primary diagnosis [ 5 , 6 ] and around equal number of patients will develop metastases within the next 5 years [ 7 ]. Lung metastases are found in about 10% of patients with newly diagnosed CRC and in 5% of patients within the next 5 years [ 8 ].…”

“…As the prognosis of patients with advanced CRC is dramatically impaired, more effective therapeutic strategies are needed. Solitary and even multiple metastases are increasingly within the limits of curative surgical treatment [ 6 ].…”

Cytoreductive surgery and HIPEC in colorectal cancer—did we get hold of the wrong end of the stick?

“…In summary CRC, even in the metastatic setting has become a disease amenable to surgical treatments and the prognosis of patients with PM has considerably improved. In different indications there are multimodal approaches, combining metastasectomy (liver/lung) with systemic chemotherapy that lead to unexpected long-term survival [28,29]. Against this background it is noteworthy that the PRODIGE 7 trial has also established an impressive median OS of >41 months with CRS alone [19].…”

Outcomes of metastasectomy and pelvic exenteration for patients with metastatic advanced primary or recurrent rectal cancer

“…Resection of visceral metastases in non‐advanced colorectal cancer produces good survival outcomes compared to non‐operative treatments, 4 and has been recommended as a standard approach. Survival benefits were also observed in those who received synchronous metastasectomy compared to those who did not receive any resection, with 3‐ and 5‐year overall survival rates after synchronous resection of metastases of 63% and 44%, compared to 7.1% and 3.3% in patients who did not have any resection 5 . However, there is a paucity of evidence supporting radical PE and synchronous resection, as opposed to metachronous resection of visceral metastases in LARC or LRRC.…”