CRC as First of Multiple Primary Malignancies Tied to Better Outcomes Than CRC as Only Malignancy
THURSDAY, June 26, 2025 -- Compared with colorectal cancer (CRC) presenting as an isolated primary or second primary malignancy, CRC presenting as the first of multiple primary malignancies less often presents at advanced stage and is associated with improved survival, according to a study published online June 17 in the Journal of the American College of Surgeons.
Anjelli Wignakumar, M.B.B.S., from Cleveland Clinic Florida in Weston, and colleagues examined features and outcomes of isolated primary CRC compared to CRC presenting in a sequence of multiple primary cancers in a retrospective cohort study. Patients were classified as CRC as the only malignancy (Group A, 424,920 patients), CRC as the first of multiple primary malignancies (Group B, 70,432 patients), and CRC as the second of multiple primary malignancies (Group C, 96,711 patients; 71.8, 11.9, and 16.3 percent, respectively).
The researchers found that patients in Group A were younger, had elevated pretreatment carcinoembryonic antigen, more frequent liver metastases, more frequent lung metastases, and systemic adjuvant treatments. More T4 tumors were included in Group A (14.5 percent versus 10.4 and 12.4 percent, respectively), and the group had less surgical treatments than Groups B and C (86.4 percent versus 94.8 and 88.1 percent, respectively). More men were included in Group B, and the group also had more left-sided CRC. Group C had more right-sided CRC. The longest overall survival and cancer-specific survival were seen for Group B (50.4 and 51.3 months, respectively).
"We expected isolated CRC patients to fare best, but patients with CRC diagnosed first, followed by another cancer had the best survival rates," Wignakumar said in a statement.
Several authors disclosed ties to the pharmaceutical and medical device industries.
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