Outcome analysis of synchronous liver limited vs synchronous lung limited resected metastases from colorectal cancer: A multicenter study

Abstract

Introduction: Surgical treatment of hepatic or pulmonary metastasis is the optimal therapeutic goal in metastatic colorectal cancer. We aim to analyze prognostic factors and outcome differences between resected liver limited vs lung limited metastases. Methods: We retrospectively analyzed 70 patients (62 patients with liver limited disease vs eight patients with lung limited disease) who underwent resection/radiofrequency of hepatic or pulmonary metastases from colorectal cancer treated in departments of medical oncology, hepatobiliary surgery and thoracic surgery in Tunisia. We compared outcome and identified prognostic factors. Results: Liver metastases were treated with surgical excision in all 62 cases. Ten patients had also radiofrequency. Metastasectomy was performed in 49 patients, segmentectomy in five patients and hepatectomy in seven patients. Lung metastases were treated with surgical excision in all eight cases: wedge resection in six and lobectomy in 2. Radiofrequency was performed in five cases. Multiple hepatic metastases (≥ 4) were present in 9 of patients, and multiple pulmonary metastases (≥ 4) were found in 5 of patients.ACE and C19-9 was initially high in 47 patients (68%) with a rate higher than 500 in 23 patients. Fifty six (80%) patients received chemotherapy. FOLFOXwas the most used regimen in 86% of cases. Half of the patients received targeted therapy: Bevacizumab in most of cases. For the overall population median OS and PFS were 44 and 32,4 months respectively. We didn't find a difference in terms of OS (45 vs 67 months, p=0.65) and PFS (27 vs 49 months, p=0.31) between the two groups. There was no prognostic impact of age (p 0,097), sex ratio (p: 0.64), type of perioperative chemotherapy (p: 0.789).DIsease-free interval (between the first and second sites of metastases) exceeding 18 months (p: 0.031); patients with less than four metastases (p: 0.027) and with tumors markers higher than 500 (p:0.042) were significant prognostic factors. Conclusion: Metastasis resection is associated with prolonged survival in patients with colorectal cancer regardless of site (hepatic or pulmonary). Patients with longer diseasefree interval, single metastases and with lower tumor markers have the best outcomes.