Clinical characteristics and prognostic impact of direct distant organ metastasis in colorectal cancer

IF 2.3 4区医学 Q3 ONCOLOGY Surgical Oncology-Oxford Pub Date : 2024-03-08 DOI:10.1016/j.suronc.2024.102063

Ching-Heng Hsiao , Yen-Liang Li , Kee-Thai Kiu , Min-Hsuan Yen , Tung-Cheng Chang

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Abstract

Background

Colorectal cancer (CRC) is the third most common type of cancer worldwide, and distant metastasis is frequently noted at diagnosis or follow-up. Notably, some patients with CRC can present with distant organ metastasis without any nodal involvement, which was defined as direct distant organ metastasis (DDOM). In this study, we evaluated the prognostic significance of DDOM for patients with CRC.

Methods

This study included 325 patients who had undergone primary colorectal cancer resection between August 2008 and December 2021. The patients with and without DDOM were compared (Kaplan–Meier analysis) in terms of overall survival (OS) and time to recurrence. Furthermore, the patients’ clinicopathological risk factors and protective factors were analyzed (multivariate Cox proportional hazards model).

Results

Of the 325 patients, 65 (20%) had DDOM (Direct⁺ group) and 260 (80%) did not (Direct⁻ group). The Kaplan–Meier analysis revealed that OS was significantly better in the Direct⁺ group than in the Direct⁻ group (p < 0.01). A subgroup analysis by CRC stage was performed; for the patients with non-stage-IV CRC, the rate of OS was significantly higher in the Direct⁺ group than in the Direct⁻ group (p = 0.02). However, DDOM did not affect the OS of the patients with stage IV CRC. The multivariate analysis indicated DDOM, left colon tumor location, and postoperative adjuvant chemotherapy were significant protective factors for disease-related mortality in the patients with non-stage-IV CRC; by contrast, body mass index, curative resection, and postoperative adjuvant chemotherapy were identified to be significant protective factors in the patients with stage IV CRC.

Conclusions

DDOM appears to be significantly associated with improved OS in patients with non-stage-IV CRC but not in those with stage IV CRC. Furthermore, the time to cancer recurrence may not vary significantly between patients with DDOM and those without it.

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大肠癌直接远处器官转移的临床特征和预后影响

背景直肠癌（CRC）是全球第三大常见癌症，在诊断或随访时经常会发现远处转移。值得注意的是，有些 CRC 患者会出现远处器官转移，但没有任何结节受累，这被定义为直接远处器官转移（DDOM）。本研究评估了 DDOM 对 CRC 患者预后的意义。研究比较了有 DDOM 和无 DDOM 患者的总生存期（OS）和复发时间（Kaplan-Meier 分析）。结果在325名患者中，65人（20%）有DDOM（直接+组），260人（80%）没有DDOM（直接-组）。Kaplan-Meier分析显示，直接+组的OS明显优于直接-组（p <0.01）。按 CRC 分期进行的亚组分析显示，对于非 IV 期 CRC 患者，Direct+ 组的 OS 率明显高于 Direct- 组（P = 0.02）。然而，DDOM 并不影响 IV 期 CRC 患者的 OS。多变量分析表明，DDOM、左侧结肠肿瘤位置和术后辅助化疗是非 IV 期 CRC 患者疾病相关死亡率的重要保护因素；相比之下，体重指数、根治性切除术和术后辅助化疗被认为是 IV 期 CRC 患者的重要保护因素。此外，有DDOM和没有DDOM的患者的癌症复发时间可能没有明显差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.