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Clinical and Pathological Risk Factors for Peritoneal Metastases in a Surgical Series of T4 Colorectal Cancers

  • 0Peritoneal Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133 Milan, Italy.
Cancers +

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April 14, 2025

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April 14, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Peritoneal metastases (PM) are a common failure site in T4 colorectal cancer (CRC). Patients with normal CEA and negative lymph nodes have a lower risk of metachronous CRC-PM, aiding in treatment selection.

Area Of Science

  • Oncology
  • Gastroenterology
  • Surgical Oncology

Background

  • T4 colorectal cancer (CRC) presents a significant risk for peritoneal metastases (PM).
  • Accurate prediction of PM development in T4 CRC patients remains challenging.
  • This study investigates the incidence and risk factors for PM in T4 CRC.

Purpose Of The Study

  • To determine the occurrence and identify risk factors for synchronous and metachronous peritoneal metastases in T4 colorectal cancer.
  • To evaluate the association of various clinico-pathological variables with PM development.
  • To inform patient selection for integrated prevention or early treatment strategies for CRC-PM.

Main Methods

  • Prospective database review of 352 patients with T4 primary CRC undergoing resection (2012-2021).
  • Univariate and multivariate analyses of clinico-pathological variables associated with synchronous or metachronous PM.
  • Median follow-up of 35.9 months to assess metachronous PM incidence and risk factors.

Main Results

  • Synchronous PM prevalence was 20.7%, associated with age, primary site, positive nodes, elevated CA19.9, and non-intestinal histology.
  • Metachronous CRC-PM occurred in 22.0% of patients with available data over a 3-year period.
  • Positive nodes and/or elevated CEA significantly increased metachronous PM risk (28.4% vs. 6.2%); combined nodal/CEA status, postoperative chemotherapy, and positive resection margins were significant predictors.

Conclusions

  • The peritoneum is a critical site for treatment failure in T4 CRC.
  • Patients with normal CEA and negative lymph nodes exhibit a substantially lower risk of metachronous CRC-PM.
  • Findings support refining patient selection for PM prevention/treatment strategies, requiring prospective validation.

Keywords:

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