Perforation Not Necessarily Poor Prognostic Factor in Patients With Metastatic CRC

Patients with metastatic colorectal cancer (CRC) may have similar overall survival regardless of whether the colon is perforated, according to new findings. The study published in the International Journal of Clinical Oncology found that those with perforation who got through the acute phase of the disease had similar outcomes as individuals without perforation.

Surgical resection of the tumor is the best treatment for stage IV CRC, but 80% are not able to undergo resection at the time of diagnosis. Colon perforation in this setting could affect the prognosis of individuals who need a metastasectomy and chemotherapy, and there is no established clinical pathway for patients with metastatic CRC and colon perforation. This study aimed to assess the clinical practice and prognosis for patients with stage IV CRC and the effect that perforation has on prognostic factors.

There were 9 cancer hospitals in Fukushima Prefecture, Japan, that were included in this study. Cancer registry data on patients with stage IV CRC as well as patient data were collected at the start of the study. Patient data included age at diagnosis, Charlson Comorbidity Index score, sex, and tumor information, such as the site of the tumor, and presence or severity of lung and liver metastases. The adjusted HR (aHR) for overall survival in the patients with a perforation was the primary outcome. Patients who had received chemotherapy within 8 weeks of diagnosis were compared with those who received it more than 8 weeks after diagnosis.

Doctor holding diagram of intestines | Image credit: © mi_viri - stock.adobe.com

There were 1258 patients included in the study who had stage IV CRC, of whom 46 had colon perforation. Four of these 46 had serious postoperative complications of resection. Pelvic abscesses were reported in 2 patients, and thrombosis or embolism were reported in 2 patients.

The aHR of overall survival with a perforation was 0.99 (95% CI, 0.61-1.28). There was an overall median (IQR) follow-up of 17.0 (6.0-32.0) months, and the median survival time was 19.0 (95% CI, 8-31) months in the perforation group compared with 20.0 (95% CI, 18-22) months in those without perforation. The overall survival of patients who received chemotherapy for distant metastases within 8 weeks was a median of 24 months (95% CI, 9-46) compared with 11 months (95% CI, 2-19) in patients who had chemotherapy after 8 months. The difference between the 2 groups was not significant, however.

There were some limitations to this study. There was a small sample size and the CI was large because of the number of cases with perforation. Perforation site was also not questioned or differentiated. The selection for chemotherapy was not based on genetic tests for RAS and BRAF due to the majority of the information coming from 2008 to 2015. New guidelines for the treatment of colon cancer for Japan came out in 2014, which could have affected the results.

The researchers concluded that perforation does not affect the prognosis for patients with stage IV CRC in terms of their overall survival and treatment date. “The results may assist clinicians engaged in the treatment of CRC with perforation in their practice,” the researchers wrote.

Reference

Nakao E, Kawamura H, Honda M, et al. Prognostic impact and survival outcomes of colon perforation in patients with metastatic colorectal cancer: a multicenter retrospective cohort study. Int J Clin Oncol. Published online December 11, 2023. doi:10.1007/s10147-023-02444-5