Metastatic site of loss of oncologic control in colorectal cancer patients.

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e15568 Background: Mortality related to colorectal cancer (CRC) is largely due to regional metastasis to portal/mesenteric lymph nodes and peritoneum as well as distant metastasis to vital organs such as lung, liver, bone and brain. Approximately 50% of patients diagnosed with CRC will develop synchronous or metachronous liver metastases, while 20% will also develop extrahepatic metastases, and the overall survival rate among patients with advanced disease is poor. However, neither the most frequent site (hepatic, pulmonary or extra-hepatic/pulmonary) of loss of oncologic control (clinical/radiological disease progression requiring change in line of Chemotherapy) nor the difference in overall survival between patients with disease progression at liver, lung or extra-hepatic/pulmonary site is well understood. Also, survival benefit of oligometastatic resection among mCRC patients remains to be investigated. Methods: A cohort of 157 patients diagnosed with stage-4 metastatic colorectal cancer (mCRC) between 2008 and 2016, and treated with chemotherapy or chemotherapy plus biologics with or without partial hepatectomy was analyzed. Metastatic disease progression and site of loss of oncologic control was assessed based on radiology data and confirmed with oncology reports (change in lines of treatment & clinical symptoms). Kaplan-Meier survival analysis was performed between different sites of oncological control as well as patients who received partial hepatectomy vs. no resection. Results: Of the 157 patients, 62 died of disease progression at the liver with an average overall survival of 822 days, 26 died of disease progression at extra-hepatic sites with an average overall survival of 996 days and 69 died of disease progression at hepatic and extrahepatic sites with an average overall survival of 887 days. For patients with metastatic disease to the liver, partial hepatectomy provides an overall survival benefit of 12 months (1141 compared to 794 days). Conclusions: This study identifies liver as the most frequent site of loss of oncological control with poor survival among mCRC patients, and data suggest that early liver-directed therapies and better liver would likely improve survival outcome in mCRC patients.

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