Sex-Associated Aspects of Referral, Resectability, and Survival in Patients with Colorectal Liver Metastases (CRLM): A Population-Based Single-Center Study of 1207 MDT-Referred Patients.

Abstract

Sex-related differences in colorectal cancer biology and care are increasingly recognized, but their impact on colorectal liver metastases (CRLM) management remains unclear. Previous Swedish registry studies suggested that women undergo CRLM surgery less often than men. This study aimed to further explore sex-associated patterns of referral rates, resectability assessment, and survival in a contemporary, multidisciplinary team (MDT)-reviewed cohort of patients with CRLM. The study enrolled all patients with CRLM referred to the Stockholm regional liver MDT between 2013 and 2021. Tumor characteristics, treatment allocation, and survival were compared by sex. Multivariable logistic and Cox regression models were used to assess predictors of resection and survival. Of 1207 MDT-referred patients, 467 (39%) were women and 740 (61%) were men. The women were younger at diagnosis and had a higher prevalence of KRAS mutations, whereas metastatic burden and extrahepatic spread were comparable between the sexes. Curative interventions were performed for 59% of the women and 62% of the men (p = 0.219), with no differences in surgical extent, complications, or postoperative outcomes. Among palliatively treated patients, survival was similar, and multivariable Cox models identified no independent association between sex and survival in any subgroup. In this large, population-based MDT cohort, sex was not associated with differences in resectability, treatment, or survival. The study underscored the importance of centralized and mandatory MDT referral pathways to ensure equitable access to curative-intent treatment and standardized management for all patients with metastatic colorectal cancer.