Patterns of metachronous metastases after curative treatment of colorectal cancer.
BACKGROUND
This study aimed to provide information on timing, anatomical location, and predictors for metachronous metastases of colorectal cancer based on a large consecutive series of non-selected patients.


METHODS
All patients operated on with curative intent for colorectal cancer (TanyNanyM0) between 2003 and 2008 in the Dutch Eindhoven Cancer Registry were included (N=5671). By means of active follow-up by the Cancer Registry staff within ten hospitals, data on development of metastatic disease were collected. Median follow-up was 5.0 years.


RESULTS
Of the 5671 colorectal cancer patients, 1042 (18%) were diagnosed with metachronous metastases. Most common affected sites were the liver (60%), lungs (39%), extra-regional lymph nodes (22%), and peritoneum (19%). 86% of all metastases was diagnosed within three years and the median time to diagnosis was 17 months (interquartile range 10-29 months). Male gender (HR=1.2, 95%CI 1.03-1.32), an advanced primary T-stage (T4 vs. T3 HR=1.6, 95%CI 1.32-1.90) and N-stage (N1 vs. N0 HR=2.8, 95%CI 2.42-3.30 and N2 vs. N0 HR=4.5, 95%CI 3.72-5.42), high-grade tumour differentiation (HR=1.4, 95%CI 1.17-1.62), and a positive (HR=2.1, 95%CI 1.68-2.71) and unknown (HR=1.7, 95%CI 1.34-2.22) resection margin were predictors for metachronous metastases.


CONCLUSIONS
Different patterns of metastatic spread were observed for colon and rectal cancer patients and differences in time to diagnosis were found. Knowledge on these patterns and predictors for metachronous metastases may enhance tailor-made follow-up schemes leading to earlier detection of metastasized disease and increased curative treatment options.
Eindhoven Cancer Registry/Comprehensive Cancer Centre the Netherlands, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands. Electronic address: y.vangestel@iknl.nl.
Yvette R B M
YR
van Gestel
Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands.
Ignace H J T
IH
de Hingh
PHARMO Institute for Drug Outcomes Research, P.O. Box 85222, 3508 AE, Utrecht, The Netherlands.
Myrthe P P
MP
van Herk-Sukel
Eindhoven Cancer Registry/Comprehensive Cancer Centre the Netherlands, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands.
Felice N
FN
van Erning
Department of Internal Medicine, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
Laurens V
LV
Beerepoot
Department of Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
Jan H
JH
Wijsman
Department of Surgery, Maxima Medical Centre, P.O. Box 90052, 5600 PD, Eindhoven, The Netherlands.
Gerrit D
GD
Slooter
Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands; Research Institute Growth & Development, Maastricht Univeristy Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Harm J T
HJ
Rutten
Department of Internal Medicine, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands.
Geert-Jan M
GJ
Creemers
Eindhoven Cancer Registry/Comprehensive Cancer Centre the Netherlands, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Valery E P P
VE
Lemmens
D000230:Adenocarcinoma / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology*; D016016:Proportional Hazards Models; D012042:Registries
Colorectal cancer; Metachronous metastases; Population-based; Predictors