A comparison of survival by site of metastatic resection (MR) in metastatic colorectal cancer (mCRC)

• Published in: Clinical colorectal cancer 2017-06, Vol.16 (2), p.e23-e28
• Main Authors: Lee-Ying, Richard, MD, Bernard, Brandon, MD, Gresham, Gillian, Chen, Leo, Speers, Caroline, Kennecke, Hagen F., MD, Lim, Howard John, MD PhD, Cheung, Winson Y., MD MPH, Renouf, Daniel John, MD MPH
• Format: Article
• Language: English
• Subjects: Aged; British Columbia; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Gastroenterology and Hepatology; Hematology, Oncology and Palliative Medicine; Humans; Kaplan-Meier Estimate; Liver metastases; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Locoregional recurrences; Lung metastases; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Male; Metastectomy; Middle Aged; Multivariate Analysis; Neoplasm Metastasis; Other distant disease; Proportional Hazards Models; Retrospective Studies; Survival Rate
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2016.07.018

Abstract Background Metastatic resection (MR) of liver-limited disease is an effective therapy for selected patients with metastatic colorectal cancer (mCRC). Despite limited data, this approach has been expanded to include MR of other sites, such as the lung, loco-regional and other distant disease (ODD). We performed a population-based study of mCRC patients who had undergone MR, and compared survival between MR of the liver and other sites. Methods Patients with mCRC referred to the British Columbia Cancer Agency between 1995 and 2010 were reviewed. Patients were included if they had an R0 MR, with a negative margin and no residual disease. Site of MR was classified according to collaborative staging criteria as liver, lung, loco-regional or ODD. Median overall survival (mOS) was assessed with Kaplan-Meier methods and compared using the log-rank test. A Cox proportional-hazards model was used to compare mOS, while adjusting for known prognostic factors. Results 2082 patients with mCRC were identified, of which 257 underwent R0 MR. Sites of MR included liver (65%), lung (16%), loco-regional (5%) and ODD (14%). The mOS of liver, lung, loco-regional and ODD were 48.0, 42.8, 37.2 and 26.2 months, respectively, p=0.087. On multivariate analysis, only MR of ODD had a significantly different survival estimate than MR of the liver, HR 1.78, 95% CI 1.13-2.80, p=0.012). Conclusions Patients with limited lung and loco-regional disease appear to confer a comparable survival advantage from MR as liver-limited metastases.