Relationship between overall survival and preoperative parameters in patients with colorectal cancer and synchronous liver and lung metastases

Background: The overall survival (OS) of patients with synchronous colorectal cancer (CRC) and pulmonary metastases (PMs) is significantly shorter, but the optimal surgical strategy, including simultaneous colorectal and liver resection vs. delayed liver metastasectomy, has not been defined. The aim of this retrospective study was to evaluate the relationship between OS and preoperative parameters, including age, number and median size of metastases, in patients with PMs from CRC and synchronous or metachronous liver metastases (LMs). Methods: The medical charts of a group of 20 patients (9 man, 11 women, median age 60 years, range 31-75) who underwent curative surgery for CRC and developed both PMs and synchronous or metachronous LMs were reviewed. Eleven patients aged <65 years, whilst 9 patients aged 65 years or older. Written informed consent was obtained from all the participants. The Pearson correlation coefficient (R) and the linear regression equation calculation was obtained. Because the data were not normally distributed, the Mann-Whitney U-test was used to evaluate statistical significance of correlations. Results: The median OS was 12.0 months (range 1-58 months) and the overall disease-free interval (DFI) was 2.7±1.9 months. The OS showed a difference in favor of the older (≥65 years) patients (43.3±21.3 vs. 20.1±23.3, p = 0.036). As expected, a strong direct linear relationship between OS and DFI (R = 0.8469, p < 0.000001) was found. There was no significant correlation between OS and both median size (R=−0.3976, p = 0.8256, regression line equation: mm = 21.820349609352-0.20184496105481OS) and number of metastases (R=−0.2975, p = 0.2025, regression line equation: Number=3.294978403666-0.039208413596717OS). Surprisingly, a direct strong relationship between OS and the age of the patients (R = 0.6098, p = 0.0043, regression line equation: age=52.147836178944 + 0.46213761830125OS) was found. Conclusions: Our results suggest that patients with both PMs and LMs from CRC aged ≥65 years should undergo metastasectomy (in lack of contraindication to surgery) regardless of other parameters, including number and size of metastases, because OS directly correlates with age. Legal entity responsible for the study: Università degli Studi di Padova Funding: Università degli Studi di Padova Disclosure: All authors have declared no conflicts of interest.