Integrating Tumour Biology into Surgical Decision-Making for Metastatic Colorectal Cancer: A Real-World Cohort Analysis Adapted for Clinical Colorectal Cancer.
- 1Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil.
- 2Thoracic and Gastrointestinal Oncology, Grupo Orizonti, Belo Horizonte 30210-080, MG, Brazil.
Abstract
Background
Metastatic colorectal cancer (mCRC) is biologically heterogeneous, resulting in variable outcomes despite similar disease burden and treatment. Although metastasectomy offers the only potentially curative option for selected patients, surgical selection remains largely anatomy based. Whether biological factors continue to influence outcomes after resection remains unclear.Methods
We retrospectively analysed 290 consecutive patients with stage IV colorectal adenocarcinoma treated at a Brazilian tertiary oncology centre (2003-2019). Tumour sidedness, RAS mutational status, and metastasectomy were evaluated for overall survival (OS) using Kaplan-Meier analysis and multivariable Cox regression in the overall cohort and the metastasectomy subgroup.Results
Median OS was 40.2 months. Patients undergoing metastasectomy had significantly longer survival than those managed non-operatively (median 116.0 vs. 30.1 months; 5-year OS 63% vs. 14%; p < 0.001). The following variables remained independently associated with improved survival: metastasectomy (HR 4.58, 95% CI 2.82-7.44; p < 0.001), RAS status (wild type vs. mutated: HR 2.77, 95% CI 1.65-4.64; p < 0.001), age (>70 ys vs. ≤ 70 HR 0.58, 95% CI 0.37-0.92; p = 0.021) and metastatic presentation (synchronous vs. metachronous: HR 0.61 95% CI 0.39-0.95; p = 0.028). RAS status remained associated with survival in patients undergoing metastasectomy (HR 3.75, 95% CI 1.46-9.60; p = 0.006).Conclusions
Tumour biology remains a dominant determinant of survival in mCRC even after metastasectomy. These data challenge purely anatomy-based surgical paradigms and support integrating molecular and clinicopathological risk into post-resection management and treatment planning.
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BibTeX
@article{goncalves2026integrating,
title = {{Integrating Tumour Biology into Surgical Decision-Making for Metastatic Colorectal Cancer: A Real-World Cohort Analysis Adapted for Clinical Colorectal Cancer.}},
author = {Mariana Paula Cunha Gonçalves and Pedro Henrique Faria Silva Trocoli-Couto and Augusto Henrique Marchiodi and Lucas Toledo Bernardo de Carvalho and Yuiti Pedro Henrique Yamashita and Henrique Araújo Lima and Vivian Resende},
journal = {Cancers},
year = {2026},
month = sep,
doi = {10.3390/cancers18193070},
url = {https://europepmc.org/article/MED/42882765},
note = {CC BY},
}
RIS
TY - JOUR
TI - Integrating Tumour Biology into Surgical Decision-Making for Metastatic Colorectal Cancer: A Real-World Cohort Analysis Adapted for Clinical Colorectal Cancer.
AU - Mariana Paula Cunha Gonçalves
AU - Pedro Henrique Faria Silva Trocoli-Couto
AU - Augusto Henrique Marchiodi
AU - Lucas Toledo Bernardo de Carvalho
AU - Yuiti Pedro Henrique Yamashita
AU - Henrique Araújo Lima
AU - Vivian Resende
PY - 2026
DA - 2026/09/22
JO - Cancers
DO - 10.3390/cancers18193070
UR - https://europepmc.org/article/MED/42882765
AB - Background Metastatic colorectal cancer (mCRC) is biologically heterogeneous, resulting in variable outcomes despite similar disease burden and treatment. Although metastasectomy offers the only potentially curative option for selected patients, surgical selection remains largely anatomy based. Whether biological factors continue to influence outcomes after resection remains unclear.Methods We retrospectively analysed 290 consecutive patients with stage IV colorectal adenocarcinoma treated at a Brazilian tertiary oncology centre (2003-2019). Tumour sidedness, RAS mutational status, and metastasectomy were evaluated for overall survival (OS) using Kaplan-Meier analysis and multivariable Cox regression in the overall cohort and the metastasectomy subgroup.Results Median OS was 40.2 months. Patients undergoing metastasectomy had significantly longer survival than those managed non-operatively (median 116.0 vs. 30.1 months; 5-year OS 63% vs. 14%; p < 0.001). The following variables remained independently associated with improved survival: metastasectomy (HR 4.58, 95% CI 2.82-7.44; p < 0.001), RAS status (wild type vs. mutated: HR 2.77, 95% CI 1.65-4.64; p < 0.001), age (>70 ys vs. ≤ 70 HR 0.58, 95% CI 0.37-0.92; p = 0.021) and metastatic presentation (synchronous vs. metachronous: HR 0.61 95% CI 0.39-0.95; p = 0.028). RAS status remained associated with survival in patients undergoing metastasectomy (HR 3.75, 95% CI 1.46-9.60; p = 0.006).Conclusions Tumour biology remains a dominant determinant of survival in mCRC even after metastasectomy. These data challenge purely anatomy-based surgical paradigms and support integrating molecular and clinicopathological risk into post-resection management and treatment planning.
SN - 2072-6694
ER -