Rumpold H, Kirchweger P, Niedersüß-Beke D, Falch D, Wundsam H, Metz-Gercek S, Piringer G, Thaler J
Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria.
Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
Acta Oncol. 2021 Feb;60(2):180-186. doi: 10.1080/0284186X.2020.1837945. Epub 2020 Oct 23.
Metastatic patterns have been linked with prognosis in colorectal cancer. We aim to determine the distribution of metastases, their dynamics during disease and their prognostic impact for specific clinical treatment scenarios (resection of metastasis and/or systemic treatment, best supportive care).
978 patients diagnosed with metastatic colorectal adenocarcinoma treated at three oncological centers from 2006 to 2018 were included. Overall survival was assessed depending on tumor load, distribution of metastases and treatment of the patients.
Most patients had single site metastasis ( = 684; 69.9%): 398 patients had liver ( = 398; 40.7%) and 103 patients had lung only metastasis (10.6%). The number of organs involved in metastases at diagnosis was highly prognostic (HR 0.77; CI 0.65, 0.90), whereas the additional gain of metastases during progression of the disease was not. The majority of patients (62.9-74.2%) with initial lung, liver or both metastases retained their initial metastatic status. In the overall population, lung only metastases were associated with the most favorable outcome (HR 0.64; CI 0.50, 0.81). This was also observed in patients receiving best supportive care (HR 0.45; CI 0.27, 0.75). Resection of lung only metastases resulted in longer median survival (102.2 months). A relevant survival difference in patients treated by systemic therapy alone was not observed. Lung only metastasis was associated with rectal cancer ( < .001) and -mutation ( = .01); both, lung and liver metastasis were associated with time from diagnosis to first metastasis ( < .001).
The number of organs involved in metastasis at diagnosis but not the total cumulative number of involved organs is of prognostic relevance in colorectal adenocarcinoma. This prognostic relevant initial metastasis distribution remains unchanged in the majority of patients during the disease. However, the prognostic impact of the metastatic pattern is potentially altered by treatment modality.
转移模式与结直肠癌的预后相关。我们旨在确定转移灶的分布、疾病过程中的动态变化及其对特定临床治疗方案（转移灶切除和/或全身治疗、最佳支持治疗）的预后影响。
纳入了2006年至2018年在三个肿瘤中心接受治疗的978例诊断为转移性结直肠腺癌的患者。根据肿瘤负荷、转移灶分布和患者治疗情况评估总生存期。
大多数患者有单部位转移（n = 684；69.9%）：398例患者有肝转移（n = 398；40.7%），103例患者仅有肺转移（10.6%）。诊断时转移灶累及的器官数量具有高度预后价值（HR 0.77；CI 0.65，0.90），而疾病进展过程中转移灶的额外增加则不然。大多数初始有肺、肝或两者转移的患者（62.9 - 74.2%）保持其初始转移状态。在总体人群中，仅有肺转移与最有利的预后相关（HR 0.64；CI 0.50，0.81）。在接受最佳支持治疗的患者中也观察到了这一点（HR 0.45；CI 0.27，0.75）。仅切除肺转移灶导致中位生存期更长（102.2个月）。未观察到仅接受全身治疗的患者有显著的生存差异。仅有肺转移与直肠癌相关（P < 0.001）和KRAS突变相关（P = 0.01）；肺和肝转移均与从诊断到首次转移的时间相关（P < 0.001）。
在结直肠腺癌中，诊断时转移灶累及的器官数量而非累及器官的总累积数量具有预后相关性。这种具有预后相关性的初始转移灶分布在大多数患者疾病过程中保持不变。然而，转移模式的预后影响可能会因治疗方式而改变。
