TY - JOUR
T1 - The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern
AU - Prasanna, Thiru
AU - Karapetis, C. S.
AU - Roder, David
AU - Tie, Jeanne
AU - Padbury, Robert T.A.
AU - Price, Timothy Jay
AU - Wong, Rachel
AU - Shapiro, Jeremy D.
AU - Nott, Louise M.
AU - Lee, Margaret M.
AU - Chua, Yujo
AU - Craft, Paul S.
AU - Piantadosi, Cynthia
AU - Sorich, Michael Joseph
AU - Gibbs, Peter
AU - Yip, Desmond
PY - 2018/11/2
Y1 - 2018/11/2
N2 - Background: Pattern of spread in patients with metastatic colorectal cancer (mCRC) is variable and may reflect different biology in subsets of patients. This is a retrospective study to explore the outcome of patients with mCRC based on their site of metastasis at diagnosis and to explore the association between tumor characteristics [KRAS/RAS, BRAF, mismatch repair (MMR) status, site of primary] and the site of metastasis. Methods: Patients from two Australian databases were divided into six groups based on site of metastasis at time of diagnosis of metastatic disease; lung-only, liver-only, lymph node-only or any patients with brain, bone or peritoneal metastases. Primary endpoint was overall survival (OS) of each cohort compared with the rest of the population. A Mantel–Haenszel chi-squared test used to explore the association between site of metastasis and selected tumor characteristics. Results: Five thousand nine hundred and sixty-seven patients were included. In a univariate analysis, median OS was significantly higher when metastases were limited to lung or liver and shorter for those with brain, bone or peritoneal metastases (p <.001) in both datasets. BRAF mutation was strongly associated with peritoneal metastases (relative risk = 1.8, p <.001) with lower incidence of lung (RR = 0.3, p =.004) and liver (RR = 0.7, p =.005) limited metastases. Lung-only metastases were more frequent with KRAS/RAS mutation (RR = 1.4, p =.007). Left colon tumors were associated with bone (RR = 1.6, p <.001) and lung-only metastases (RR = 2.3, p =.001) while peritoneal spread was less frequent compared with right colon tumors (RR = 0.6, p <.001). Rectal cancer was associated with brain, bone and lung metastases (RR = 1.7; p =.002, 1.7; p <.001, 2.0; p <.001). Liver-only metastases were less frequent in deficient MMR tumors (RR = 0.7, p =.01). Conclusion: Survival duration with mCRC is related to the site of metastases with lung limited disease showing a more favorable survival outcome compared to other single metastatic site disease. The BRAF mutation and primary rectal cancer were associated with poor prognostic metastatic sites.
AB - Background: Pattern of spread in patients with metastatic colorectal cancer (mCRC) is variable and may reflect different biology in subsets of patients. This is a retrospective study to explore the outcome of patients with mCRC based on their site of metastasis at diagnosis and to explore the association between tumor characteristics [KRAS/RAS, BRAF, mismatch repair (MMR) status, site of primary] and the site of metastasis. Methods: Patients from two Australian databases were divided into six groups based on site of metastasis at time of diagnosis of metastatic disease; lung-only, liver-only, lymph node-only or any patients with brain, bone or peritoneal metastases. Primary endpoint was overall survival (OS) of each cohort compared with the rest of the population. A Mantel–Haenszel chi-squared test used to explore the association between site of metastasis and selected tumor characteristics. Results: Five thousand nine hundred and sixty-seven patients were included. In a univariate analysis, median OS was significantly higher when metastases were limited to lung or liver and shorter for those with brain, bone or peritoneal metastases (p <.001) in both datasets. BRAF mutation was strongly associated with peritoneal metastases (relative risk = 1.8, p <.001) with lower incidence of lung (RR = 0.3, p =.004) and liver (RR = 0.7, p =.005) limited metastases. Lung-only metastases were more frequent with KRAS/RAS mutation (RR = 1.4, p =.007). Left colon tumors were associated with bone (RR = 1.6, p <.001) and lung-only metastases (RR = 2.3, p =.001) while peritoneal spread was less frequent compared with right colon tumors (RR = 0.6, p <.001). Rectal cancer was associated with brain, bone and lung metastases (RR = 1.7; p =.002, 1.7; p <.001, 2.0; p <.001). Liver-only metastases were less frequent in deficient MMR tumors (RR = 0.7, p =.01). Conclusion: Survival duration with mCRC is related to the site of metastases with lung limited disease showing a more favorable survival outcome compared to other single metastatic site disease. The BRAF mutation and primary rectal cancer were associated with poor prognostic metastatic sites.
UR - http://www.scopus.com/inward/record.url?scp=85050571162&partnerID=8YFLogxK
U2 - 10.1080/0284186X.2018.1487581
DO - 10.1080/0284186X.2018.1487581
M3 - Article
SN - 0284-186X
VL - 57
SP - 1438
EP - 1444
JO - Acta Oncologica
JF - Acta Oncologica
IS - 11
ER -
