Colorectal
Kyle R. Stephens, MD
Resident
University of Louisville, Department of Surgery
Georgetown, Indiana, United States
Kyle R. Stephens, MD
Resident
University of Louisville, Department of Surgery
Georgetown, Indiana, United States
Kyle R. Stephens, MD
Resident
University of Louisville, Department of Surgery
Georgetown, Indiana, United States
Walter Donica, MD
General Surgery Resident
University of Louisville
Louisville, Kentucky, United States
Michael E. Egger, MD, MPH
Surgical oncologist
University of Louisville
Louisville, Kentucky, United States
Prejesh Philips, MD
Associate Professor of Surgery
University of Louisville, Kentucky, United States
Charles Scoggins, MD
Surgical Oncologist
Department of Surgery, University of Louisville, United States
Kelly McMasters, MD, PhD (he/him/his)
Ben A. Reid, Sr., MD Professor and Chair
The Hiram C. Polk Jr., MD Department of Surgery University of Louisville School of Medicine
Louisville, Kentucky, United States
Robert CG Martin, II, MD
Surgical Oncologist
Department of Surgery, University of Louisville
Louisville, Kentucky, United States
Margin-negative (R0) resection of limited metastatic colon cancer (MCC), in conjunction with systemic antineoplastic agents, is the primary treatment strategy, leading to long survival times for appropriately selected patients. However, we have seen a near 70% drop in resectable/borderline resectable MCC at the University of Louisville in the past 5 years. The aim of this study was to perform a review of the National Cancer Database (NCDB) to corroborate our local incidence data.
Methods:
Stage was defined by the AJCC 8th edition which implemented a new category in 2018 of M1c/stage 4c disease as defined by peritoneal surface metastasis/carcinomatosis, while M1a/stage 4a and M1b/stage 4b were similarly defined as metastasis confined to one or two anatomical sites, respectively, without peritoneal metastasis. University of Louisville data was acquired from an IRB approved prospective hepatic database from 2002 to 2023. The NCDB Participant User File (PUF) 2020 data was reviewed after appropriate IRB approval was granted. The data was read into SAS 9.4 and all data analysis was performed with this software. Chi square analysis was performed on categorical data, and p-values < 0.05 were considered significant.
Results:
Our institutional data identified a 28% drop in Stage 4A disease (figure) from 2017 to present. This change has also led to a 72% drop in surgical resections/ablation for resectable/borderline resectable MCC (Figure). The NCDB PUF 2020 for colon cancer diagnoses from 2018 to 2020, identified 215,334 MCC patients. Mean and median age was 66.85 and 68. 50.03% of patients were male. 80.47% of patients were white, 13.08% were black, and 8.76% reported Hispanic origins. 12.56% of tumors were pT1, 11.86% pT2, 44.13% pT3, and 20.51% pT4. 31.06% of patient’s baseline CEA was not elevated, 11.01% were microsatellite instability high, and 6.96% had KRAS mutations. Between 2018 and 2020 clinical and pathological M1a/stage 4a and M1b/stage 4b decreased annually, while M1c/stage 4c either increased or stayed the same. In all of these cases the differences were statistically significant on chi square analysis with a p-value of < 0.001. Between 2018-2020 annual incidence of p4a disease decreased from 58.37% to 49.90%, p4b decreased from 22.11% to 21.16%, and p4c increased from 24.22% to 28.94% (Figure).
Conclusions:
A significant change in the distribution of colon cancer metastases has occurred at an institutional and national level over the past 3-5 years. Interdisciplinary treatment strategies will have to be modified accordingly.