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Survival and Prognostic Factors for Metachronous Peritoneal Metastasis in Patients with Colon Cancer

Hiroshi Nagata MD, Soichiro Ishihara MD, PhD, Keisuke Hata MD, PhD, Koji Murono MD, PhD, Manabu Kaneko MD, PhD, Koji Yasuda MD, PhD, Kensuke Otani MD, PhD, Takeshi Nishikawa MD, PhD, Toshiaki Tanaka MD, PhD, Tomomichi Kiyomatsu MD, PhD, Kazushige Kawai MD, PhD, Hiroaki Nozawa MD, PhD, Toshiaki Watanabe MD, PhD
Colorectal Cancer
Volume 24, Issue 5 / May , 2017

Abstract

Background

The clinical course of metachronous peritoneal metastasis of colorectal origin is poorly understood. In this retrospective study, we aimed to elucidate survival and prognostic factors for metachronous peritoneal metastasis.

Methods

Patients with metachronous peritoneal metastasis after curative resection for stage I–III colon cancer were retrospectively reviewed, and the incidence and prognosis of metachronous peritoneal metastasis were investigated. Prognostic factors were identified by univariate and multivariate analyses.

Results

Among 1582 surgically resected stage I–III colon cancer patients, 65 developed metachronous peritoneal metastasis. The 5-year cumulative incidence rate was 4.5%, and the median survival after diagnosis of peritoneal metastasis was 29.6 months. None of the patients underwent peritonectomy or intraperitoneal chemotherapy. Independent prognostic factors included right colon cancer [hazard ratio (HR) 2.69, 95% confidence interval (CI) 1.26–5.64; p = 0.011], time to metachronous peritoneal metastasis of <1 year (HR 2.02, 95% CI 1.04–3.87; p = 0.040), Peritoneal Cancer Index (PCI) >10 (HR 3.68, 95% CI 1.37–8.99; p = 0.012), concurrent metastases (HR 4.09, 95% CI 2.02–8.23; p < 0.001), and peritoneal nodule resection (HR 0.31, 95% CI 0.13–0.65; p = 0.002).

Conclusions

A proportion of colon cancer patients with metachronous peritoneal metastasis may benefit from combined peritoneal nodule resection and systemic chemotherapy. Right colon cancer, early peritoneal metastasis, a high PCI, and concurrent metastases negatively affected prognosis in patients with metachronous peritoneal metastasis.

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