Primary Tumor Versus Liver-First Strategy in Patients with Stage IVA Colorectal Cancer: A Propensity Score Analysis of Long-term Outcomes and Recurrence Pattern.

Abstract

The optimal strategy in patients with stage IVA colorectal cancer remains debated. This study was designed to compare the long-term outcomes and the pattern of recurrence following classical (CS) versus reverse (RS) strategy. Data from all consecutive patients, who have completed the CS and RS, were retrospectively reviewed. A propensity score matching (PSM) was performed on 1:2 (RS:CS) ratio to obtain two groups matched for tumor characteristics. Survival and recurrence pattern were investigated before and after matching. The study population included 161 patients: 145 treated with CS versus 16 with RS. Five-year overall survival (OS, 51.5 vs. 42.7 %, p = 0.91) and recurrence-free survival (RFS, 20.5 vs. 20.6 %, p = 0.15) were not different between the two strategies. The median time to recurrence (TTR) whatever the site was significantly shorter in the RS group than in the CS group (3.5 vs. 13 months, p = 0.02). Extrahepatic recurrence was significantly more frequent (37.5 vs. 16.6 %; p = 0.04) and occurred earlier after treatment completion in the RS group than in the CS group (3.4 vs. 16.4 months, p = 0.009). Similar findings in terms of OS, RFS, median TTR whatever the site and proportion of extrahepatic recurrence were observed after PSM. Stage IVA colorectal cancer patients who have completed the CS or RS had similar OS. Extrahepatic recurrence is more frequent and occurs earlier after RS. Postoperative locoregional therapy and active follow-up strategies should be considered in RS patients.