The Relevance of Curative-Intent Metastasectomy in Colorectal Cancer Patients: Real-World Insights From a Certified...

Long-term survival in metastatic colorectal cancer (mCRC) can be achieved by curative-intent metastasectomy. Patients ineligible for upfront (primary) metastasectomy (PM) may become candidates for secondary metastasectomy (SM) following response to primary chemotherapy (PCT), still with curative intent. Most studies focus either on resectable or unresectable mCRC, limiting insights into differential subgroup benefits. Here, real-world data offer a comprehensive evaluation of PM, SM, and PCT. We analyzed real-world data from mCRC patients treated at the certified Comprehensive Cancer Center of the LMU Hospital (CCC Munich^LMU) from 2007 to 2021, following ESMO's guidance for real-world evidence (GROW). Overall survival (OS) data were matched with the Bavarian Cancer Registry. OS was assessed using Kaplan-Meier estimates and Cox regression analysis, adjusting for prognostic factors, including primary tumor sidedness and number of metastatic sites. Of 840 evaluable patients, 166 (20%) underwent PM, 520 (62%) received PCT, and 109 (13%) became eligible for SM after response to systemic treatment. OS was significantly longer for PM versus PCT (82.3 vs. 41.6 months, HR = 0.47, p < 0.0001). Multivariate analysis confirmed PM benefit across all subgroups, including high-risk patients (e.g., right-sided and multisite mCRC). OS was comparable between PM and SM (82.3 vs. 80.9 months), whereas patients ineligible for local treatments had the worst OS (25 months). Both PM and SM were associated with excellent OS, also for patients with high-risk mCRC. Our findings underscore the importance of initial evaluation and continuous reassessment of resectability throughout the course of treatment against mCRC, as implemented at the CCC Munich^LMU.