Clinical characteristics and prognostic impact of direct distant organ metastasis in colorectal cancer

Ching Heng Hsiao, Yen Liang Li, Kee Thai Kiu, Min Hsuan Yen, Tung Cheng Chang

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Colorectal cancer (CRC) is the third most common type of cancer worldwide, and distant metastasis is frequently noted at diagnosis or follow-up. Notably, some patients with CRC can present with distant organ metastasis without any nodal involvement, which was defined as direct distant organ metastasis (DDOM). In this study, we evaluated the prognostic significance of DDOM for patients with CRC. Methods: This study included 325 patients who had undergone primary colorectal cancer resection between August 2008 and December 2021. The patients with and without DDOM were compared (Kaplan–Meier analysis) in terms of overall survival (OS) and time to recurrence. Furthermore, the patients’ clinicopathological risk factors and protective factors were analyzed (multivariate Cox proportional hazards model). Results: Of the 325 patients, 65 (20%) had DDOM (Direct+ group) and 260 (80%) did not (Direct group). The Kaplan–Meier analysis revealed that OS was significantly better in the Direct+ group than in the Direct group (p < 0.01). A subgroup analysis by CRC stage was performed; for the patients with non-stage-IV CRC, the rate of OS was significantly higher in the Direct+ group than in the Direct group (p = 0.02). However, DDOM did not affect the OS of the patients with stage IV CRC. The multivariate analysis indicated DDOM, left colon tumor location, and postoperative adjuvant chemotherapy were significant protective factors for disease-related mortality in the patients with non-stage-IV CRC; by contrast, body mass index, curative resection, and postoperative adjuvant chemotherapy were identified to be significant protective factors in the patients with stage IV CRC. Conclusions: DDOM appears to be significantly associated with improved OS in patients with non-stage-IV CRC but not in those with stage IV CRC. Furthermore, the time to cancer recurrence may not vary significantly between patients with DDOM and those without it.

Original languageEnglish
Article number102063
JournalSurgical Oncology
Volume53
DOIs
Publication statusPublished - Apr 2024

Keywords

  • Colorectal cancer
  • Direct distant organ metastasis
  • Lymph node
  • Recurrence
  • Skip metastasis
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

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