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. 2019 Dec 26;17(1):228.
doi: 10.1186/s12957-019-1771-9.

Synchronous and metachronous liver metastases in patients with colorectal cancer-towards a clinically relevant definition

Jennie Engstrand  1 , Cecilia Strömberg  2 , Henrik Nilsson  3 , Jacob Freedman  3 , Eduard Jonas  2   4
Affiliations

Synchronous and metachronous liver metastases in patients with colorectal cancer-towards a clinically relevant definition

Jennie Engstrand et al. World J Surg Oncol. .

Abstract

Background: Approximately 25% of patients with colorectal cancer (CRC) will have liver metastases classified as synchronous or metachronous. There is no consensus on the defining time point for synchronous/metachronous, and the prognostic implications thereof remain unclear. The aim of the study was to assess the prognostic value of differential detection at various defining time points in a population-based patient cohort and conduct a literature review of the topic.

Methods: All patients diagnosed with CRC in the counties of Stockholm and Gotland, Sweden, during 2008 were included in the study and followed for 5 years or until death to identify patients diagnosed with liver metastases. Patients with liver metastases were followed from time of diagnosis of liver metastases for at least 5 years or until death. Different time points defining synchronous/metachronous detection, as reported in the literature and identified in a literature search of databases (PubMed, Embase, Cochrane library), were applied to the cohort, and overall survival was calculated using Kaplan-Meier curves and compared with log-rank test. The influence of synchronously or metachronously detected liver metastases on disease-free and overall survival as reported in articles forthcoming from the literature search was also assessed.

Results: Liver metastases were diagnosed in 272/1026 patients with CRC (26.5%). No statistically significant difference in overall survival for synchronous vs. metachronous detection at any of the defining time points (CRC diagnosis/surgery and 3, 6 and 12 months post-diagnosis/surgery) was demonstrated for operated or non-operated patients. In the literature search, 41 publications met the inclusion criteria. No clear pattern emerged regarding the prognostic significance of synchronous vs. metachronous detection.

Conclusion: Synchronous vs. metachronous detection of CRC liver metastases lacks prognostic value. Using primary tumour diagnosis/operation as standardized cut-off point to define synchronous/metachronous detection is semantically correct. In synchronous detection, it defines a clinically relevant group of patients where individualized multimodality treatment protocols will apply.

Keywords: Colorectal cancer; Liver metastases; Metachronous; Synchronous.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The time of detection of the liver metastases as related to the time of detection of the primary tumour (non-operated, palliative)/operation for the primary tumour (resected)
Fig. 2
Fig. 2
a–d Overall survival curves for synchronous and metachronous detected metastases. Operated and non-operated patients shown for the different synchronous/metachronous cut-off points at a, detection of the primary tumour (non-operated, palliative)/operation for the primary tumour (resected) and b, 3 months, c, 6 months and d, 12 months after detection/resection of the primary tumour
Fig. 3
Fig. 3
The flow chart presenting the results of the electronic database search
See this image and copyright information in PMC

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