Yvette R B M van Gestel1, Ignace H J T de Hingh2, Myrthe P P van Herk-Sukel3, Felice N van Erning4, Laurens V Beerepoot5, Jan H Wijsman6, Gerrit D Slooter7, Harm J T Rutten8, Geert-Jan M Creemers9, Valery E P P Lemmens10. 1. Eindhoven Cancer Registry/Comprehensive Cancer Centre the Netherlands, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands. Electronic address: y.vangestel@iknl.nl. 2. Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands. 3. PHARMO Institute for Drug Outcomes Research, P.O. Box 85222, 3508 AE, Utrecht, The Netherlands. 4. Eindhoven Cancer Registry/Comprehensive Cancer Centre the Netherlands, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands. 5. Department of Internal Medicine, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands. 6. Department of Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands. 7. Department of Surgery, Maxima Medical Centre, P.O. Box 90052, 5600 PD, Eindhoven, The Netherlands. 8. 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. 9. Department of Internal Medicine, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands. 10. 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.
Abstract
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.
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 cancerpatients, 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 cancerpatients 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.
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