Related Experiment Video
Updated: May 30, 2025
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Factors Affecting the Prognosis after Primary Tumor Resection for Patients with Metastatic Colorectal Cancer with
Satoru Kagami1, Kimihiko Funahashi1, Hirotoshi Kobayashi2,3
1Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan.
Objectives:
To clarify the risk factors affecting prognosis after primary tumor resection (PTR) in patients with metastatic colorectal cancer with synchronous peritoneal metastasis (mCRC-SPM).
Methods:
Patients were enrolled prospectively in the JSCCR project "Grading of Peritoneal Seeding in Colorectal Cancer." Factors that may influence overall survival-age, sex, location of the primary tumor, lymph node metastasis, presence of liver metastasis, degree of peritoneal metastasis, peritoneal cancer index (PCI), cancer cure, and postoperative chemotherapy-in the PTR group were examined using multivariate analysis.
Results:
Of the 133 enrolled patients with mCRC-SPM, 112 patients underwent PTR. Among them, 26 (23.2%) had mCRC-SPM of grade P1, 47 (42.0%) of P2, and 39 (34.8%) of P3. The median PCI was 4 (range, 1-28); no surgery-related deaths occurred. Postoperative complications of Clavien-Dindo classification ≥grade 2 were observed in 20 (17.9%) patients. R0 surgery became more difficult as the degree of dissemination increased, and the PTR group had a significantly better prognosis than the non-PTR group. In the multivariate analysis, age ≥75 years, rectal cancer, presence of liver metastasis, higher PCI, non-curative resection, and non-treatment with systemic chemotherapy were associated with poor prognosis in patients after PTR.
Conclusions:
In patients with mCRC-SPM, postoperative complications are infrequent for P1 with localized peritoneal dissemination, and PTR may be considered as aggressive treatment. Factors including age ≥75 years, rectal cancer, presence of liver metastasis, increased PCI, non-curative resection, and non-treatment with systemic chemotherapy are associated with a reduced survival benefit from PTR.
