Abstract
BackgroundThis population‐based study aimed to examine the incidence, patterns and results of multimodal management of metastatic colorectal cancer.MethodsA retrospective population‐based study was conducted on patients with metastatic colorectal cancer in Central Finland in 2000–2015. Clinical and histopathological data were retrieved and descriptive analysis was conducted to determine the pattern of metastatic disease, defined as synchronous, early metachronous (within 12 months of diagnosis of primary disease) and late metachronous (more than 12 months after diagnosis). Subgroups were compared for resection and overall survival (OS) rates.ResultsOf 1671 patients, 296 (17·7 per cent) had synchronous metastases, and 255 (19·6 per cent) of 1302 patients with resected stage I–III tumours developed metachronous metastases (94 early and 161 late metastases). Liver, pulmonary and intraperitoneal metastases were the most common sites. The commonest metastatic patterns were a combination of liver and lung metastases. The overall metastasectomy rate for patients with synchronous metastases was 16·2 per cent; in this subgroup, 3‐ and 5‐year OS rates after any resection were 63 and 44 per cent respectively, compared with 7·1 and 3·3 per cent following no resection (P < 0·001). The resection rate was higher for late than for early metachronous disease (28·0 versus 17 per cent respectively; P = 0·048). Three‐ and 5‐year OS rates after any resection of metachronous metastases were 78 and 62 per cent respectively versus 42·1 and 18·2 per cent with no metastasectomy (P < 0·001). Similarly, 3‐ and 5‐year OS rates after any metastasectomy for early metachronous metastases were 57 and 50 per cent versus 84 and 66 per cent for late metachronous metastases (P = 0·293).ConclusionThe proportion of patients with metastatic colorectal cancer was consistent with that in earlier population‐based studies, as were resection rates for liver and lung metastases and survival after resection. Differentiation between synchronous, early and late metachronous metastases can improve assessment of resectability and survival.
Highlights
Colorectal carcinoma is the third most common cancer worldwide[1,2] and the fourth leading cause of cancer death[1]
All patients with colorectal primary and metastatic disease were discussed in multidisciplinary team (MDT) meetings before definitive treatment decisions were made
Three and 5-year overall survival (OS) rates after liver resection for early metachronous metastases were 54 and 46 per cent respectively, and for late metachronous metastases 81 and 67 per cent (P = 0⋅319). This population-based study in Finland covering the years 2000–2015 showed that the proportion of patients with colorectal cancer diagnosed with synchronous (17⋅7 per cent) or metachronous (19⋅6 per cent) metastases was consistent with earlier large population-based studies[7,8,9] reporting synchronous or metachronous metastases in approximately 15–25 per cent of all patients with colorectal cancer
Summary
Colorectal carcinoma is the third most common cancer worldwide[1,2] and the fourth leading cause of cancer death[1]. Many improvements have been made in the management of primary and metastatic colorectal cancer[3,4,5]. Kellokumpu impact of these improvements at a population level is not well known[6] This population-based study aimed to examine the incidence, patterns and results of multimodal management of metastatic colorectal cancer. Three- and 5-year OS rates after any resection of metachronous metastases were 78 and 62 per cent respectively versus 42⋅1 and 18⋅2 per cent with no metastasectomy (P < 0⋅001). Conclusion: The proportion of patients with metastatic colorectal cancer was consistent with that in earlier population-based studies, as were resection rates for liver and lung metastases and survival after resection. Differentiation between synchronous, early and late metachronous metastases can improve assessment of resectability and survival
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