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. 2022 Oct 23;14(10):e30607.
doi: 10.7759/cureus.30607. eCollection 2022 Oct.

Real-Life Experience of the Prognostic Significance of the Primary Tumor Location on the Timing of Colorectal Liver Metastases: A Retrospective Analysis

Carlo Signorelli  1 , Pietro Maria Amodio  2 , Mario Giovanni Chilelli  1 , Roberto Santoro  2 , Marta Schirripa  1 , Teresa Valentina Ranalli  2 , Gloria Pessina  3 , Julio Rodrigo Giron Berrios  1 , Federica Natoni  3 , Antonella Virtuoso  1 , Francesca Primi  1 , Marco Mazzotta  1 , Fabrizio Nelli  1 , Agnese Fabbri  1 , Eleonora Marrucci  1 , Enzo Maria Ruggeri  1
Affiliations

Real-Life Experience of the Prognostic Significance of the Primary Tumor Location on the Timing of Colorectal Liver Metastases: A Retrospective Analysis

Carlo Signorelli et al. Cureus. .

Abstract

Background Numerous research studies have looked into how the primary tumor location (PTL) affects patients' prognosis for colorectal cancer (CRC). Our research aimed to investigate the prognostic effects of PTL in patients with synchronous (SM) and metachronous (MM) colorectal cancer liver metastases (CRCLM). Material and methods From 2016 to 2021, we looked back at the records of patients at our institute who were affected by CRCLM. Results 109 patients were included, of whom 21.1% received CRCLM resection (R0=73.9%), with 57.7% having left-sided colon cancer (LCC) and 42.2% having right-sided colon cancer (RCC). SM predominated (69.7%). The median duration of follow-up was 21,3 months (95%CI=15,4-25,2). ≥5 hepatic metastases prevailed in the SM group (N=61; 83.5%). 21% of all patients underwent CRCLM resection (R0=78.2%). We observed a double rate of patients unresponsive to standard systemic antineoplastic treatments in the SM group (35.8% vs. 17.9% of the MM group) (p=0.27). We found a significantly longer median overall survival (OS) in patients with MM-LCC compared with the other groups (27.7 months; HR=0.3797; 95%CI=0.19-0.74; p=0.0205). The median OS, regardless of PTL, was higher in the MM group (16,5 months vs. 16,1 months; HR=0,29; 95%CI=0,13-0,67; p=0.0038) as well as progression-free survival (PFS) (11 months vs. 10,2 months; HR=0,61; 95%CI=0,33-1,12; p=0.11). Finally, in patients undergoing liver surgery, a noteworthy median OS was shown to be significantly in favor of patients with metachronous liver metastases from the primary left tumor (37.0 months; HR=0.47; 95%CI=0.11-1.96; p=0.0041). Conclusions Our real-life study demonstrated that patients with LCC, particularly MM-LCC, have the highest survival and that the timing of CRCLM should be a prognostic factor.

Keywords: colorectal cancer; hepatic metastases; metachronous liver metastases; primary tumor location; synchronous liver metastases.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart showing the criteria for inclusion and exclusion
Figure 2
Figure 2. Kaplan-Meier curves of Overall Survival stratified by primary tumor location and timing of liver metastases.
SM-RCC, synchronous metastases from right-sided colon cancer; SM-LCC, synchronous metastases from left-sided colon cancer; MM-RCC, metachronous metastases from right-sided colon cancer; MM-LCC, metachronous metastases from left-sided colon cancer
Figure 3
Figure 3. Kaplan-Meier curves of Progression-Free Survival stratified by primary tumor location and timing of liver metastases.
SM-RCC, synchronous metastases from right-sided colon cancer; SM-LCC, synchronous metastases from left-sided colon cancer; MM-RCC, metachronous metastases from right-sided colon cancer; MM-LCC, metachronous metastases from left-sided colon cancer
Figure 4
Figure 4. Kaplan-Meier curves of Overall Survival stratified by timing of liver metastases.
SM, synchronous metastases; MM, metachronous metastases
Figure 5
Figure 5. Kaplan-Meier curves of Progression-Free Survival stratified by timing of liver metastases.
SM, synchronous metastases; MM, metachronous metastases
Figure 6
Figure 6. Kaplan-Meier curves of Overall Survival in patients after curative-intent surgery for colorectal cancer liver metastases stratified by primary tumor location and timing of liver metastases.
SM-RCC, synchronous metastases from right-sided colon cancer; SM-LCC, synchronous metastases from left-sided colon cancer; MM-RCC, metachronous metastases from right-sided colon cancer; MM-LCC, metachronous metastases from left-sided colon cancer
Figure 7
Figure 7. Kaplan-Meier curves of Progression-Free Survival in patients after curative-intent surgery for colorectal cancer liver metastases stratified by primary tumor location and timing of liver metastases.
SM-RCC, synchronous metastases from right-sided colon cancer; SM-LCC, synchronous metastases from left-sided colon cancer; MM-RCC, metachronous metastases from right-sided colon cancer; MM-LCC, metachronous metastases from left-sided colon cancer
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