Prognostic Significance of the Location of Colorectal Cancer Metastases
An Austrian study presented at the ESMO 2020 conference analyzed the relationship between the localization of colorectal cancer (CRC) metastases and patient survival, the time of metastasis detection, and RAS mutations.
Prognostic Factors in CRC
Metastases are detected in about half of CRC patients at the time of diagnosis. They most commonly affect the liver and lungs. Previous studies have suggested a connection between CRC patient survival and the timing of metastases, the affected organ, the localization of the primary tumor, and the presence of mutations.
Retrospective Analysis
The authors retrospectively analyzed 2915 CRC patients treated at 3 Austrian oncology centers from 2006 to 2019. Metastatic disease was present in 1079 of them. The primary parameter monitored was overall survival (OS) based on the localization of the metastases: only in the liver, only in the lungs, only in the peritoneum, or other, compared to the rest of the population.
Findings
Overall Survival Based on CRC Metastasis Localization
The most favorable survival outcomes were observed in patients with lung-only metastases. Their OS reached 30.7 months (p < 0.001). For patients treated with systemic therapy plus metastasectomy, OS was 39.7 months in cases of lung metastases (p = 0.008) and 27.1 months in cases of liver metastases (p = 0.02). In patients receiving the best palliative care, the longest OS was also observed in the case of lung-only metastases: 14.6 months (p = 0.002). In the group of patients receiving only systemic therapy, no significant correlation between the localization of metastases and OS was found.
Other Parameters Related to CRC Metastasis Localization
The authors further report that lung-only metastatic involvement was associated with the localization of the primary tumor in the rectum, metachronous occurrence of metastases, and RAS mutation. Liver-only metastatic involvement significantly correlated only with the synchronous occurrence of metastases.
Conclusion
This work demonstrated that CRC patient survival is influenced by the localization of metastases. The longest OS was observed in cases where metastatic involvement was limited to the lung area.
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Source: Kirchweger P., Wundsam H., Niedersüß-Beke D. et al. 506P Relation of metastasis localization, survival outcome and treatment modality in metastatic colorectal cancer. Ann Oncol 2020; 31 (suppl. 4): S454−S455, doi: 10.1016/j.annonc.2020.08.616.
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