Early-Onset Colorectal Cancer With Liver-Only Metastases: A Retrospective Cohort Study Integrating Prospectively Collected Real-World Clinical and Molecular Data From an Australian National Database (2009-2024) to Guide Treatment Planning

Barreto, SG; Karapetis, CS; Ullah, S; Burge, M; Caird, S; Campbell, A; Jalali, A; Jennens, R; Khattak, MA; Lee, B; Lim, SH; Mendis, S; Nott, L; Price, TJ; Shapiro, JD; Tie, J; Torres, J; Williams, C; Wong, R; Wong, V; Gibbs, P

Author(s): Barreto, SG; Karapetis, CS; Ullah, S; Burge, M; Caird, S; Campbell, A; Jalali, A; Jennens, R; Khattak, MA; Lee, B; Lim, SH; Mendis, S; Nott, L; Price, TJ; Shapiro, JD; Tie, J; Torres, J; Williams, C; Wong, R; Wong, V; Gibbs, P;
Details: Publication Year 2026-08,Volume 224,Issue #8,Page e70266
Journal Title: Medical Journal of Australia
Publication Type: Research article
Abstract: OBJECTIVE: To leverage the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry (an Australian cancer database) to explore the ideal timing and sequence of therapies and the factors influencing these decisions in colorectal cancer (CRC) patients with liver-only metastases to inform contemporary decision-making and future trials. STUDY TYPE: Retrospective registry-based cohort study using the TRACC registry. SETTING AND PARTICIPANTS: Consecutive patients with liver-only metastatic CRC enrolled in the TRACC registry. MAIN OUTCOME MEASURES: To explore cancer biology, intended treatment at presentation, actual treatment received and the resultant outcomes for early-onset CRC (EOCRC) (≤ 50 years) and late-onset CRC (LOCRC) (> 50 years) patients with liver-only metastases from a real-world perspective. RESULTS: Between 14 January 2009 and 2 September 2024, 1691 patients with liver-only metastatic CRC were enrolled in TRACC. These included 276 EOCRC patients (16.3%) and 1415 LOCRC patients (83.7%). In the EOCRC subset, there were more females (48.2% vs. 34.5%, p < 0.001), less comorbidity (Charlson comorbidity index score 0, 90% vs. 59%, p < 0.001), more left-sided primaries (76.1% vs. 65.7%, p < 0.001), more synchronous disease (53.3% vs. 42.1%, p < 0.001) and BRAF V600E mutations (13.9% vs. 8.1%; p = 0.010). Overall, EOCRC patients had a longer median survival compared with LOCRC patients (3.20 vs. 2.38 years, p < 0.001). For the 662 patients (39.1%) undergoing liver resection, median survival was 5.99 years in EOCRC patients and 5.88 years in LOCRC patients. For all patients and for those undergoing resection, respectively, B-Raf proto-oncogene, serine/threonine kinase (BRAF) (hazard ratio, 1.97 [p < 0.001] and hazard ratio, 2.25 [p < 0.001]) and Kirsten rat sarcoma viral oncogene homologue (KRAS) mutations were associated with worse outcomes (hazard ratio, 1.29 [p < 0.001] and hazard ratio, 1.34 [p = 0.003]). CONCLUSION: Differences in sex distribution, BRAF mutation rates, primary tumour site and overall survival suggest biological differences between EOCRC and LOCRC. Liver resection was associated with improved survival in LOCRC, with the benefits of all therapies varying depending on age, primary tumour site and whether patients presented with synchronous or metachronous liver-only metastases.; The known:Australia has the highest incidence of early‐onset colorectal cancer (CRC) globally. The new:This study, using real‐world data from an Australian cancer database, demonstrates differences in cancer biology, tumour location and treatment sequence and differences in overall survival between early‐onset CRC and late‐onset CRC patients with liver‐only metastases. The implications:These findings warrant consideration of a selective aggressive approach to managing CRC patients with liver‐only metastases based on disease burden, presence of comorbidities and an understanding of the patient's unique tumour biology.; eng
Publisher: Wiley
Keywords: Humans; Female; *Colorectal Neoplasms/pathology/therapy/genetics/mortality; *Liver Neoplasms/secondary/therapy/genetics/mortality; Male; Middle Aged; Retrospective Studies; Australia/epidemiology; Aged; Registries; Proto-Oncogene Mas; Adult; Proto-Oncogene Proteins B-raf/genetics; Age of Onset; Databases, Factual; Aged, 80 and over; cancer; carcinoma; chemotherapy; colorectal neoplasms; digestive system neoplasms; liver neoplasms; surgical oncology
Department(s): Medical Oncology
Publisher's Version: https://doi.org/10.5694/mja2.70266
Open Access at Publisher's Site: https://doi.org/10.5694/mja2.70266
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-09-03 12:44:08

Last Modified: 2026-09-03 12:44:21