A Comparison of Survival by Site of Metastatic Resection in Metastatic Colorectal Cancer

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Micro-AbstractMetastatic resection (MR) of liver-limited disease is an effective therapy in metastatic colorectal cancer and has been adopted to other disease sites. We assessed 257 patients who underwent R0 MR and compared survival on the basis of the site of MR. Lung and locoregional MR seem to confer a comparable survival advantage to liver MR, whereas MR of other distant disease does not.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, locoregional, and other distant disease (ODD). We performed a population-based study of patients with mCRC who had undergone MR and compared survival between MR of the liver and MR of other sites.Methods:Patients with mCRC who were 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. The site of MR was classified according to collaborative staging criteria as liver, lung, locoregional, 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:A total of 2082 patients with mCRC were identified, of whom 257 underwent R0 MR. Sites of MR included liver (65%), lung (16%), locoregional (5%), and ODD (14%). The mOS of liver, lung, locoregional, and ODD were 48.0, 42.8, 37.2, and 26.2 months, respectively (P = .087). On multivariate analysis, only MR of ODD had a significantly different survival estimate than MR of the liver (hazard ratio, 1.78; 95% confidence interval, 1.13-2.80; P = .012).Conclusions:Patients with limited lung and locoregional disease seem to have a comparable survival advantage from MR as patients with liver-limited metastases.

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