Analysis Of Distant Metastasis Of Colorectal Cancer With Liver Metastasis

Objective: Colorectal cancer is one of the most common gastrointestinal malignancy.Distant metastasis of colorectal cancer is also a common cause of cancer-related death.We performed this study is to investigate the characteristics and regularities of distant metastasis patterns of colorectal cancer with hepatic metastases and to identify the risk factors for colorectal cancer with hepatic and extrahepatic metastases.For Clinicians,they can better identify high-risk groups in colorectal liver metastasis and develop individualized treatment programs and follow-up protocols.Methods: The clinical data of patients about colorectal liver metastasis with or without extrahepatic metastasis who had complete clinical data during the period between December 2011 and December 2016 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Clinical Pathology factors division by ?2test for group analysis and Logistic regression analysis were used to explore potential risk factors.A value of P<0.05 was considered statistically significant.Results: The clinic data of 382 patients with colorectal liver metastasis were analyzed.Of the 382 patients,187 patients with rectal cancer and 195 patients with colon cancer.Among them,228 male patients and 154 female patients.The ratio of male to female was 1.48:1;Age range 20-87 years old with the average age(58.25 + 12.75).The simultaneous liver metastases of colon cancer and rectal cancer were 65.1% and 60.4% respectively.Colon cancer and rectal cancer had higher rates of multiple liver metastases(81% and 81.3%,respectively).Patients with rectal and colon cancer were more likely to have simultaneous liver metastases and multiple liver metastases,but there was no significant difference between the two groups(p > 0.05).For patients with rectal cancer,patients with colon cancer were more likely to have liver and extrahepatic metastases(35.8% vs 47.2%,p<0.05).A total of 159 patients with colorectal hepatic and extrahepatic metastases were found in both groups.The most common site of metastasis in patients with extrahepatic metastases was lung.Both colon cancer and rectal cancer had a higher proportion of lung metastasis,and a larger proportion of patients with rectal cancer had lung metastasis,up to 61.2%,while no statistical difference in colon and rectal cancer were observed about extrahepatic lung metastasis.Colon cancer patients were more likely to be associated with peritoneal and retroperitoneal metastasis than rectal cancer patients and this difference is statistically significant(P < 0.05).There was no significant difference in pelvic and skeletal metastasis between colon cancer and rectal cancer(p>0.05).Although there were more cases of colon cancer with more than 2 extrahepatic metastases than rectal cancer,the difference between the two groups was not statistically significant(28.3% vs 19.4%,p>0.05).More importantly,we found that the serum CEA and CA199 were significantly higher in patients with hepatic and extrahepatic metastasis in colorectal cancer than those in patients with liver metastasis alone(294.9±43.9ng/l vs 146.5±17.4ng/l,513.9±75.4u/ml vs 207.7±21.2u/ml;p < 0.05).In this study,51 patients underwent PET/CT examination,among them,30 patients with liver and extrahepatic metastasis and 21 patients with liver metastasis alone.The specificity and sensitivity of PET/CT in diagnosing extrahepatic metastasis from colorectal liver metastases with were100% and 93.75%,respectively.Logistic multivariate regression analysis showed that CEA,CA19-9 and multiple hepatic metastasis were the risk factors for colorectal cancer combined with liver and extrahepatic metastasis,while age,sex,and simultaneous liver metastasis were not associated with the occurrence of liver and extrahepatic metastasis in colorectal cancer due to the difference was not statistically significant.Conclusion:1.The distant metastasis pattern of colon cancer and rectal cancer is different.Colorectal liver metastasis often presents as multiple liver metastases.Colon cancer is more likely to combine with hepatic and extrahepatic metastasis than rectal cancer,and colon cancer is more prone to develop peritoneal and peritoneal metastasis than rectal cancer.Lung is the most common organ of extrahepatic metastasis of colorectal cancer.2.If CEA or CA199 increases significantly in patients with colorectal liver metastasis,they are more likely to be associated with extrahepatic tumor metastasis.Such patients should be evaluated more aggressively to detect potential distant metastatic lesions.3.Age,sex and simultaneous liver metastasis in patients with liver metastasis from colorectal cancer have no significant correlation with colorectal hepatic and extrahepatic metastasis.