TY - JOUR
T1 - Local Treatment of Colorectal Liver Metastases in the Presence of Extrahepatic Disease
T2 - Survival Outcomes from the Amsterdam Colorectal Liver Met Registry (AmCORE)
AU - Schulz, Hannah H.
AU - Dijkstra, Madelon
AU - van der Lei, Susan
AU - Vos, Danielle J. W.
AU - Timmer, Florentine E. F.
AU - Puijk, Robbert S.
AU - Scheffer, Hester J.
AU - van den Tol, M. Petrousjka
AU - Lissenberg-Witte, Birgit I.
AU - Buffart, Tineke E.
AU - Versteeg, Kathelijn S.
AU - Swijnenburg, Rutger-Jan
AU - Meijerink, Martijn R.
N1 - Publisher Copyright: © 2024 by the authors.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Background: The simultaneous presence of colorectal liver metastases (CRLMs) and extrahepatic metastases in patients with colorectal cancer (CRC) can be considered a relative contraindication for local treatment with curative intent. This study aims to assess the survival outcomes of patients with CRLMs and extrahepatic metastases after comprehensive local treatment of all metastatic sites. Methods: Patients with CRLMs who received local treatment of all metastatic sites were extracted from the prospective AmCORE registry database and subdivided into two groups: CRLM only vs. CRLM and extrahepatic metastasis. To address potential confounders, multivariate analysis was performed. The primary endpoint was overall survival (OS). Results: In total, 881 patients with CRLM only and 60 with CRLM and extrahepatic disease were included, and the median OS was 55.7 months vs. 42.7 months, respectively. Though OS was significantly lower in patients with concomitant extrahepatic metastases (HR 1.477; 95% CI 1.029–2.121; p = 0.033), the survival curve plateaued after 6.2 years. Extrahepatic manifestations were pulmonary (43.3%), peritoneal (16.7%) and non-regional lymph node metastases (10.0%). In patients with pulmonary and non-regional lymph node metastases, OS did not significantly differ from patients with CRLM-only disease; concomitant peritoneal metastases showed an inferior OS (HR 1.976; 95% CI 1.017–3.841, p = 0.041). Conclusions: In this comparative series, OS was inferior for patients with multi-organ metastatic CRC versus patients with CRLMs alone. Nonetheless, the long-term survival curve plateau seemed to justify local treatment in a subset of patients with multi-organ metastatic CRC, especially for patients with CRLMs and pulmonary or lymph node metastases.
AB - Background: The simultaneous presence of colorectal liver metastases (CRLMs) and extrahepatic metastases in patients with colorectal cancer (CRC) can be considered a relative contraindication for local treatment with curative intent. This study aims to assess the survival outcomes of patients with CRLMs and extrahepatic metastases after comprehensive local treatment of all metastatic sites. Methods: Patients with CRLMs who received local treatment of all metastatic sites were extracted from the prospective AmCORE registry database and subdivided into two groups: CRLM only vs. CRLM and extrahepatic metastasis. To address potential confounders, multivariate analysis was performed. The primary endpoint was overall survival (OS). Results: In total, 881 patients with CRLM only and 60 with CRLM and extrahepatic disease were included, and the median OS was 55.7 months vs. 42.7 months, respectively. Though OS was significantly lower in patients with concomitant extrahepatic metastases (HR 1.477; 95% CI 1.029–2.121; p = 0.033), the survival curve plateaued after 6.2 years. Extrahepatic manifestations were pulmonary (43.3%), peritoneal (16.7%) and non-regional lymph node metastases (10.0%). In patients with pulmonary and non-regional lymph node metastases, OS did not significantly differ from patients with CRLM-only disease; concomitant peritoneal metastases showed an inferior OS (HR 1.976; 95% CI 1.017–3.841, p = 0.041). Conclusions: In this comparative series, OS was inferior for patients with multi-organ metastatic CRC versus patients with CRLMs alone. Nonetheless, the long-term survival curve plateau seemed to justify local treatment in a subset of patients with multi-organ metastatic CRC, especially for patients with CRLMs and pulmonary or lymph node metastases.
KW - colorectal cancer (CRC)
KW - colorectal liver metastases (CRLMs)
KW - extra hepatic colorectal metastases
KW - irreversible electroporation
KW - local treatment
KW - partial hepatectomy
KW - stereotactic ablative radiotherapy
KW - surgical resection
KW - thermal ablation
UR - http://www.scopus.com/inward/record.url?scp=85188786443&partnerID=8YFLogxK
U2 - 10.3390/cancers16061098
DO - 10.3390/cancers16061098
M3 - Article
C2 - 38539433
SN - 2072-6694
VL - 16
JO - Cancers
JF - Cancers
IS - 6
M1 - 1098
ER -