PSM
Amy Y. Li, MD
Fellow Physician
University of California, Irvine, Department of Surgery, United States
Amy Y. Li, MD
Fellow Physician
University of California, Irvine, Department of Surgery, United States
Amy Y. Li, MD
Fellow Physician
University of California, Irvine, Department of Surgery, United States
Rhami Khorfan, MD
Fellow Physician
Loma Linda University, Department of Surgery, United States
.jpg "Shaina Sedighim, MD photo")
Shaina Sedighim, MD
Resident Physician
University of California, Irvine, Department of Surgery
Irvine, California, United States
Monique Gandawidjaja, MD
Resident
University of California, Irvine, United States
Michael P. O’Leary, MD (he/him/his)
Attending Surgeon
Loma Linda University, Department of Surgery
Loma Linda, California, United States
Maheswari Senthil, MD (she/her/hers)
Chief of Surgical Oncology
University of California, Irvine
Irvine, California, United States
.jpg "Oliver Eng, MD (he/him/his) photo")
Oliver Eng, MD (he/him/his)
Associate Professor of Surgery
University of California, Irvine
Orange, California, United States
The development of multimodal therapy in the management of oligometastatic colorectal cancer (CRC) has evolved over the past several decades. Pooled historic data from multiple clinical trials for metastatic CRC in the 1990-2000s demonstrated varying survival depending on oligometastatic site, with isolated peritoneal metastasis (PM) conferring the worst survival over isolated lung and isolated liver metastases (16 vs 23 and 18 months, respectively). Therefore, we sought to examine a more contemporary national cohort to characterize survival among patients with oligometastatic CRC in the context of evolving multimodal therapy.
Methods:
The National Cancer Database (NCDB) was queried for all adult patients diagnosed with Stage IV CRC between 2016 and 2020. Patients were grouped by the following oligometastatic sites: lung, liver, and peritoneal. Subsets of patients who received systemic therapy (chemotherapy and/or immunotherapy) alone or received both systemic therapy and surgery were assessed. Demographics were evaluated and Kaplan-Meier analyses were performed to assess survival differences between metastatic sites.
Results:
A total of 53,138 patients with oligometastatic CRC were identified. Of these patients, 8.3% (n=4,428) had isolated lung, 71.9% (n=38,198) with isolated liver, and 19.8% (n=10,512) with isolated PM. Median age ranged from 63-66 years across the groups. Over half of the isolated lung and liver patients were men (53-58%), while 54% of isolated PM patients were women. Most patients in each group were non-Hispanic white (90-91%), and about 72-74% of patients had a Charlson-Deyo Score of 0. Median overall survival (OS) was 24.1 months, with 31.5-month, 24.7-month, and 19-month survival for isolated lung, liver, and peritoneal metastases respectively (p< 0.001). Within the cohort, 16,453 (31.0%) patients received systemic therapy alone, and 22,227 (41.8%) received both systemic therapy and surgery. OS for isolated PM patients who received systemic therapy alone was worse compared to isolated lung and liver metastases (15.3 vs 29.3 and 20.5 months, p< 0.001). However, OS was improved by almost two-fold for patients who received both systemic therapy and surgery (34.4 vs 51.8 and 43.9 months, p< 0.001).
Conclusions:
Overall survival in patients with oligometastatic colorectal cancer differs among metastatic sites. In a contemporary cohort, survival with systemic therapy alone remains limited. Conversely, receipt of multimodal therapy is associated with durable longer-term survival, likely reflecting evolving treatment paradigms.