Advertisement

Prognostic differences between oligometastatic and polymetastatic disease after resection in patients with colorectal cancer and hepatic or lung metastases: Retrospective analysis of a large cohort at a single institution

Published:November 15, 2022DOI:https://doi.org/10.1016/j.surg.2022.10.014

      Abstract

      Background

      Long-term survival data are lacking, and prognostic factors are not well-defined for patients with colorectal cancer and hepatic or lung metastases. This study evaluated the outcomes after resection of oligometastatic hepatic or lung metastases from colorectal cancer and sought to identify prognostic factors.

      Methods

      We retrospectively investigated 1,123 patients with colorectal cancer and hepatic or pulmonary metastases who underwent curative surgery between January 1991 and December 2016.

      Results

      Of the 1,123 patients, 719 had hepatic metastases, 287 had pulmonary metastases, and 117 had both. The 5-year overall survival rate was 52.3% in the hepatic metastases group, 70.4% in the pulmonary metastases group, and 71.4% in the hepatic and pulmonary metastases group (P < .001). In total, 1,045 patients had oligometastases (1–5 metastatic lesions in 1 or 2 organs) and 78 had polymetastases (≥6 metastases in 1 or 2 organs). Prognosis was significantly better in patients with oligometastases than in those with polymetastases. The 5-year overall survival rate was 59.0% in the oligometastases group and 35.3% in the polymetastases group (P < .001); the respective 5-year relapse-free survival rates were 37.5% and 11.6% (P < .001). Multivariable analysis identified predictors of both poor overall survival and relapse-free survival to be a high carcinoembryonic antigen level before the first metastasectomy, largest metastasis measuring ≥2 cm, polymetastases, and synchronous metastases.

      Conclusion

      Prognosis after curative resection was better in patients with oligometastatic colorectal cancer in the liver or lung than in those with polymetastases. Multidisciplinary decision-making strategies, including about surgery, should be based on number of metastases rather than their site.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • van der Pool A.E.
        • Damhuis R.A.
        • Ijzermans J.N.
        • et al.
        Trends in incidence, treatment and survival of patients with stage IV colorectal cancer: a population-based series.
        Colorectal Dis. 2012; 14: 56-61
        • Abdalla E.K.
        • Vauthey J.N.
        • Ellis L.M.
        • et al.
        Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.
        Ann Surg. 2004; 239 (discussion 25–7): 818-825
        • Choti M.A.
        • Sitzmann J.V.
        • Tiburi M.F.
        • et al.
        Trends in long-term survival following liver resection for hepatic colorectal metastases.
        Ann Surg. 2002; 235: 759-766
        • Pawlik T.M.
        • Scoggins C.R.
        • Zorzi D.
        • et al.
        Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases.
        Ann Surg. 2005; 241 (discussion 22–24): 715-722
        • Pfannschmidt J.
        • Dienemann H.
        • Hoffmann H.
        Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series.
        Ann Thorac Surg. 2007; 84: 324-338
        • Riquet M.
        • Foucault C.
        • Cazes A.
        • et al.
        Pulmonary resection for metastases of colorectal adenocarcinoma.
        Ann Thorac Surg. 2010; 89: 375-380
        • Lee W.S.
        • Yun S.H.
        • Chun H.K.
        • et al.
        Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival.
        Int J Colorect Dis. 2007; 22: 699-704
        • Watanabe K.
        • Nagai K.
        • Kobayashi A.
        • Sugito M.
        • Saito N.
        Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer.
        Br J Surg. 2009; 96: 1058-1065
        • Headrick J.R.
        • Miller D.L.
        • Nagorney D.M.
        • et al.
        Surgical treatment of hepatic and pulmonary metastases from colon cancer.
        Ann Thorac Surg. 2001; 71 (discussion 9–80): 975-979
        • Kobayashi K.
        • Kawamura M.
        • Ishihara T.
        Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer.
        J Thorac Cardiovasc Surg. 1999; 118: 1090-1096
        • Regnard J.F.
        • Grunenwald D.
        • Spaggiari L.
        • et al.
        Surgical treatment of hepatic and pulmonary metastases from colorectal cancers.
        Ann Thorac Surg. 1998; 66 (discussion 8–9): 214-218
        • Shah S.A.
        • Haddad R.
        • Al-Sukhni W.
        • et al.
        Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma.
        J Am Coll Surg. 2006; 202: 468-475
        • Neeff H.
        • Horth W.
        • Makowiec F.
        • et al.
        Outcome after resection of hepatic and pulmonary metastases of colorectal cancer.
        J Gastrointest Surg. 2009; 13: 1813-1820
        • Mise Y.
        • Kopetz S.
        • Mehran R.J.
        • et al.
        Is complete liver resection without resection of synchronous lung metastases justified?.
        Ann Surg Oncol. 2015; 22: 1585-1592
        • Andres A.
        • Mentha G.
        • Adam R.
        • et al.
        Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases.
        Br J Surg. 2015; 102: 691-699
        • Miller G.
        • Biernacki P.
        • Kemeny N.E.
        • et al.
        Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases.
        J Am Coll Surg. 2007; 205: 231-238
        • Brouquet A.
        • Vauthey J.N.
        • Contreras C.M.
        • et al.
        Improved survival after resection of liver and lung colorectal metastases compared with liver-only metastases: a study of 112 patients with limited lung metastatic disease.
        J Am Coll Surg. 2011; 213 (discussion 9–71): 62-69
        • Gonzalez M.
        • Robert J.H.
        • Halkic N.
        • et al.
        Survival after lung metastasectomy in colorectal cancer patients with previously resected liver metastases.
        World J Surg. 2012; 36: 386-391
        • Hellman S.
        • Weichselbaum R.R.
        Oligometastases.
        J Clin Oncol. 1995; 13: 8-10
        • Filippi A.R.
        • Guerrera F.
        • Badellino S.
        • et al.
        Exploratory analysis on overall survival after either surgery or stereotactic radiotherapy for lung oligometastases from colorectal cancer.
        Clin Oncol (R Coll Radiol). 2016; 28: 505-512
        • Kinj R.
        • Bondiau P.Y.
        • Francois E.
        • et al.
        Radiosensitivity of colon and rectal lung oligometastasis treated with stereotactic ablative radiotherapy.
        Clin Colorect Cancer. 2017; 16: e211-e220
        • Wild A.T.
        • Yamada Y.
        Treatment options in oligometastatic disease: stereotactic body radiation therapy—Focus on colorectal cancer.
        Visc Med. 2017; 33: 54-61
        • Lu F.
        • Poruk K.E.
        • Weiss M.J.
        Surgery for oligometastasis of pancreatic cancer.
        Chin J Cancer Res. 2015; 27: 358-367
        • Van Cutsem E.
        • Cervantes A.
        • Adam R.
        • et al.
        ESMO consensus guidelines for the management of patients with metastatic colorectal cancer.
        Ann Oncol. 2016; 27: 1386-1422
        • Andres A.
        • Majno P.E.
        • Morel P.
        • et al.
        Improved long-term outcome of surgery for advanced colorectal liver metastases: reasons and implications for management on the basis of a severity score.
        Ann Surg Oncol. 2008; 15: 134-143
        • Fong Y.
        • Fortner J.
        • Sun R.L.
        • Brennan M.F.
        • Blumgart L.H.
        Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.
        Ann Surg. 1999; 230 (discussion 18–21): 309-318
        • Salah S.
        • Watanabe K.
        • Park J.S.
        • et al.
        Repeated resection of colorectal cancer pulmonary oligometastases: pooled analysis and prognostic assessment.
        Ann Surg Oncol. 2013; 20: 1955-1961
        • Cha Y.J.
        • Kim M.S.
        • Jang W.I.
        • et al.
        Stereotactic body radiation therapy for liver oligo-recurrence and oligo-progression from various tumors.
        Radiat Oncol J. 2017; 35: 172-179
        • Lin J.
        • Peng J.
        • Zhao Y.
        • et al.
        Early recurrence in patients undergoing curative resection of colorectal liver oligometastases: identification of its clinical characteristics, risk factors, and prognosis.
        J Cancer Res Clin Oncol. 2018; 144: 359-369
        • Niibe Y.
        • Nishimura T.
        • Inoue T.
        • et al.
        Oligo-recurrence predicts favorable prognosis of brain-only oligometastases in patients with non-small cell lung cancer treated with stereotactic radiosurgery or stereotactic radiotherapy: a multi-institutional study of 61 subjects.
        BMC Cancer. 2016; 16: 659
        • Mazzola R.
        • Corradini S.
        • Gregucci F.
        • Figlia V.
        • Fiorentino A.
        • Alongi F.
        Role of radiosurgery/stereotactic radiotherapy in oligometastatic disease: brain oligometastases.
        Front Oncol. 2019; 9: 206
        • Habl G.
        • Straube C.
        • Schiller K.
        • et al.
        Oligometastases from prostate cancer: local treatment with stereotactic body radiotherapy (SBRT).
        BMC Cancer. 2017; 17: 361
        • Kanemitsu Y.
        • Shimizu Y.
        • Mizusawa J.
        • et al.
        Hepatectomy followed by mFOLFOX6 versus hepatectomy alone for liver-only metastatic colorectal cancer (JCOG0603): a phase II/III randomized controlled trial.
        J Clin Oncol. 2021; 39: 3789-3799
        • Hashiguchi Y.
        • Muro K.
        • Saito Y.
        • et al.
        Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer.
        Int J Clin Oncol. 2020; 25: 1-42