EP710 - Distinct Survival Impact of Liver Metastasis in Metastatic Colon Cancer: the Role of Hepatic Involvement Compared to Other Metastatic Sites

ePoster Presenter(s)

• 

  Alexander A. Xu, MD, MS (he/him/his)

  Fellow
  Beth Israel Deaconess Medical Center
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

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Author(s)

• 

  Ana Sofia Ore, MD MSc MPH (she/her/hers)

  General Surgery Resident
  Beth Israel Deaconess Medical Center/Harvard Medical School
  Beth Israel Deaconess Medical Center/Harvard Medical School
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Patricia Marcolin, MD (she/her/hers)

  Research Fellow
  Beth Israel Deaconess Medical Center
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• TC

  Thomas E. Cataldo, MD, FASCRS

  Assistant professor of Surgery
  BIDMC
  Boston, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• KC

  Kristen Crowell, MD

  Assistant Professor of Surgery
  Division of Colon and Rectal Surgery, Beth Isreal Deaconess Medical Center
  Boston, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• DW

  Daniel Wong, MD

  Colorectal Surgeon
  Beth Israel Deaconess Medical Center
  Boston, Massachusetts, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Evangelos Messaris, MD, PhD, MBA

  Associate Professor of Surgery
  Division of Colon and Rectal Surgery, Beth Isreal Deaconess Medical Center
  Boston, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Recent investigation of novel treatments for metastatic colorectal cancer have been promising, however, patients with liver involvement have been observed to have poorer response to these treatments. It appears that patients with liver metastases have a different biological behavior from patients with metastatic colorectal cancer but without liver metastases. We aimed to explore the association between liver metastasis in metastatic colon cancer and overall survival.

Methods/Interventions: The National Cancer Database was analyzed for the years 2004-2020 for all patients over 18 years old with clinical M1 colon adenocarcinoma as defined by the AJCC. Demographics, clinical characteristics of the patients and their cancers, and survival were compared between patients with and without liver metastases. The association between liver involvement and 5-year survival was analyzed using multivariable Cox proportional hazards regression. Covariates included age of diagnosis, sex, primary tumor location in the colon, tumor histology, presence of other metastases, and treatment including surgery of the primary tumor, surgery on a metastatic site, chemotherapy, radiotherapy, or immunotherapy.

Results/Outcomes: 77,634 cases of metastatic colon cancer were analyzed. 59,703 cases (77%) had liver involvement. In unadjusted analysis, patients with liver involvement had worse survival compared to patients without liver involvement. Patients with liver involvement were more likely to have left-sided cancers and were more likely to have classic adenocarcinoma (95% vs 83%, p< 0.005). After adjustment, patients with liver metastases had significantly decreased survival compared to those without liver metastases (hazard ratio (HR) 1.38 [1.35,1.41]), a greater effect than lung involvement, brain involvement, or bone involvement (HR 1.14 [1.12,1.16], 1.37 [1.29,1.47], 1.26 [1.21,1.31], respectively). Left-sided cancers (descending colon, sigmoid colon, and rectosigmoid junction) were associated with better survival (0.89 [0.85,0.94], 0.85 [0.83,0.88], 0.83 [0.80, 0.86]) compared to right-sided and transverse colon cancers. Both mucinous adenocarcinoma and signet ring cell carcinoma were associated with worse survival (HR 1.15 [1.11,1.19] and 1.78 [1.68,1.89], respectively) compared to classic adenocarcinoma. Stratified by isolated liver involvement, isolated lung involvement, liver involvement with other organ metastases, and other organ metastases without liver involvement, patients with liver involvement with additional organ metastases had the worst survival outcomes.

Conclusion/Discussion: Liver involvement in metastatic colon adenocarcinoma is an independent marker for decreased survival, compared to metastases to other organs such as lung, brain, and bone. Further investigation is warranted to better understand metastatic colon cancer biology when liver involvement is present.

5-Year Survival in Metastatic Colon Cancer by Organ Involvement
Survival plot over 5 years for patients with metastatic colon cancer, stratified by liver involvement only, lung involvement only, other organ involvement including liver, and other organ involvement without liver involvement.

Characteristics of Patients with Metastatic Colon Cancer with and without Liver Involvement