title: Predictors of long-term survival in patients with stage IV colorectal cancer with multi-organ metastases: a single-center retrospective analysis.
abstract: BACKGROUND
  The prognosis for most patients with stage IV colorectal cancer (CRC) and multi-organ metastases is poor. However, little information is currently available on prognostic factors in these patients. The aim of this study was to identify predictors of a good prognosis in this patient group.
  
  
  METHODS
  This was a single-center retrospective study in which we examined the relationship between patient characteristics and prognosis in 161 stage IV CRC patients with indications for first-line systemic chemotherapy. Cox proportional-hazards models were used to compute hazard ratios (HR) for death, adjusted for clinical and pathological characteristics.
  
  
  RESULTS
  Of the 161 patients recruited to the study, 83 had single-organ and 78 had multi-organ metastases. Median survival time was significantly shorter in patients with multi-organ metastases than in those with single-organ metastases (19.2 vs. 42.0 months, respectively; log-rank, P < 0.001). There was no significant difference in survival between patients with metastases in two versus three or more organs (log-rank; P = 0.368). According to univariate analysis, primary tumor sites in the left side of the colon and in the rectum, a pretreatment carcinoembryonic antigen concentration of >50 ng/mL, a well-/moderately differentiated tumor, and R0 resection of metastatic lesions were associated with better overall survival. According to multivariate analysis, left-sided location of the primary tumor [HR 0.414, 95 % confidence interval (CI) 0.216-0.815; P = 0.011] and R0 resection of metastatic lesions (HR 0.247, 95 % CI 0.04 0-0.834; P = 0.021) were independently associated with good prognosis.
  
  
  CONCLUSIONS
  Our results indicate that the site of the primary tumor in the left side of the colon and in the rectum and R0 resection of metastatic lesions are predictors of a good prognosis in patients with stage IV CRC and multi-organ metastases.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. miyamotoyuji@gmail.com.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Department of Surgery, National Hospital Organization Kumamoto Hospital, 2338 Matsubase, Uki, 869-0593, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Mayuko
authors.initials: M
authors.lastname: Ohuchi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Ryuma
authors.initials: R
authors.lastname: Tokunagam
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Kurashige
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Hiyoshi
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Baba
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Iwagami
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. hdobaba@kumamoto-u.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002272:Carcinoembryonic Antigen / Q000097:blood; D044683:Colon, Descending / Q000473:pathology*; D003110:Colonic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D002272:Carcinoembryonic Antigen
keywords: Colorectal cancer; Multi-organ metastasis; Prognostic factor; Stage IV