M. Koss1, R. Thusay1, J. Sabbasani2, P. Silberstein1 1Creighton University Medical Center, School Of Medicine, Omaha, NE, USA 2Wright State University, School Of Medicine, Dayton, OH, USA
Introduction:
Liver metastases present significant challenges in the treatment and management of colon cancer (CC), a cancer that continues to grow in incidence in the United States in individuals below the traditional ages of screening. Metastasectomy in addition to primary tumor resection provides an avenue to improve long-term survival outcomes in patients with early-onset CC presenting with metastases to the liver. This procedure has the potential to improve survival and is a vital part of a comprehensive treatment strategy for select patients. This study aims to assess the efficacy of metastasectomy in the treatment of early onset, stage IV CC presenting with metastasis to the liver to help us build a more comprehensive picture of the current paradigms of treatment and how that extends to the younger population.
Methods:
The National Cancer Database was used to identify patients diagnosed with primary colon cancer before the age of 50 that presented with metastases to the liver between 2016-2020 who received a primary surgical resection of the colon. They were stratified based on treatment approach and survival differences were analyzed using Kaplan-Meier and Cox regression analysis that accounted for the differences in tumor burden and co-morbidities between patients.
Results:
Analysis identified 687 patients meeting criteria, with 224 receiving a metastasectomy in addition to primary resection and 463 receiving a primary resection only. Univariate analysis showed significantly greater mean survival outcomes for patients receiving the metastasectomy in addition to primary resection (56.740 months, 95% CI: 50.815-62.665 months) compared to those receiving the primary resection only (27.630 months, 95% CI: 24.676-30.584 months). Multivariate analysis showed improved survival for patients receiving metastasectomy in addition to primary resection (HR: 0.491, 95% CI: 0.381-0.634, p<0.001) when compared to patients receiving primary resection only.
Conclusion:
For patients with early-onset CC presenting with liver metastases, a liver metastasectomy in addition to primary tumor resections appears to offer a significant benefit for long-term survival based on the results of this study. For select patients, metastasectomy offers an additional effective option that can help reduce tumor burden and improve long-term survival. Many factors go into a treatment decision, but this may offer an added benefit to those that elect to it. Due to the complex nature of such patients, more work needs to be done to try to account for more variables such as surgical approach, facility type or use of adjuvant therapies.