Influence of metastatic site as an additional predictor for response and outcome in advanced colorectal carcinoma

Every year, 31 230 men and women are diagnosed with colorectal carcinoma, a nd up to 60% of these will ultimately develop advanced disease. However, th ere is little information to identify which patients are most likely to ben efit from palliative chemotherapy. This analysis is unique in evaluating ho w the site of metastasis influences response and survival. A database of 49 7 patients treated within randomized clinical trials using 5-Fluorouracil ( 5FU)-based chemotherapy at the Royal Marsden Hospital was analysed. The pot ential for site of metastasis as a predictive variable for response to chem otherapy and survival was examined, in addition to other clinical parameter s. The presence of liver metastases was a better predictor for overall resp onse than either performance status or number of metastatic sites on presen tation. Probability of response was significantly decreased by a raised ser um carcinoembryonic antigen (CEA) and presence of peritoneal metastases. In liver metastases, a normal serum albumin was as significant a predictor fo r response as good performance status. The most important predictor for sur vival was initial performance status. The number of metastatic sites on pre sentation had no influence on survival. Site of metastasis can predict for response to 5FU-based chemotherapy and patients should be stratified accord ing to the involved site of metastasis in the future.