Synchronous metastases from colorectal cancer. Treatment and long-term survival compared to patients with metachronous metastases: a population-based study from Central Norway 2001-2015

Abstract

Background: Reliable and modern information on primary evaluation, treatment, and long-term survival rates for patients with colorectal cancer (CRC) metastases are needed. Whether synchronous CRC metastases carry a worse prognosis than metachronous is still debated.

Methods: Population-based study on 7,950 CRC patients from Central Norway, 2001- 2015. Of these, 1,843 (23.2%) had synchronous metastases and of radically operated patients with stage I-III disease 1,117 (20.1%) developed metachronous metastases. The treatment strategies and outcomes for patients with metastases were analyzed, stratified by three consecutive 5-year periods.

Results: Median and 3-year survival for patients with synchronous metastases were 11 months and 16.4%, compared to 17 months and 29.4% with metachronous metastases, p < 0.001 and p < 0.001, respectively. The subsets receiving supportive care only, had a median survival of 3-4 months. Patients with synchronous metastases and primary palliative chemotherapy had a median survival of 15 months compared to 18 months with metachronous metastases, p < 0.001. Neither groups improved survival across the study period. The 5-year survival for the 342/1,843 (18.6%) patients with synchronous metastases and curative intent treatment was 41.8% compared to 43.6% for the corresponding 422/1,117 (37.8%) patients with metachronous metastases, log-rank p = 0.281. Survival significantly improved for both these groups across the study period.

Interpretation: A key determinant of better survival for patients with metachronous CRC metastases compared to synchronous was a significantly higher proportion treated with curative intent. Survival for both patients with synchronous and metachronous metastases taken collectively steadily improved during the study period, driven by the increased proportions and improved survival for the subsets with curative intent treatment.

Figure 1

Anatomical distribution of CRC metastases 2001–2015 for patients in the curative intent treatment groups, stratified by synchronous (n = 342) and metachronous (n = 422) detection. χ² p < 0.001. *local recurrences included.

Figure 2

Overall survival for patients with CRC metastases 2001–2015 and curative intent treatment, stratified by time period. (a) synchronous metastases (n = 342). Period I versus II, log rank p = 0.098, period I versus III, log rank p < 0.001, and period II versus III log rank p = 0.012. (b) metachronous metastases (n = 422), period I versus II, log rank p = 0.047, period I versus III, log rank p = 0.017, and period II versus III, log rank p = 0.997.

Figure 3

Overall survival for patients with CRC metastases 2001–2015 and curative intent treatment. (a) stratified by synchronous (n = 342) versus metachronous (n = 422) detection of metastases, log rank p = 0.281. (b) stratified by early metachronous (<12 months) and late metachronous (>12 months) detection of metastases, log rank p = 0.989.