FACTORS ASSOCIATED WITH SYNCHRONOUS METASTATIC PRESENTATION AND 24-MONTH PROGRESSION-FREE SURVIVAL IN COLORECTAL CANCER
DOI:
https://doi.org/10.22551/MSJ.2026.03.05Keywords:
COLORECTAL CANCER; SYNCHRONOUS METASTASES; MAGNETIC RESONANCE IMAGING; EXTRA-MURAL VENOUS INVASION; CIRCUMFERENTIAL RESECTION MARGIN; RISK STRATIFICATIONAbstract
Early identification of patients presenting with synchronous metastatic colorectal cancer (mCRC) is essential for optimizing staging and treatment. This study aimed to identify preoperative MRI-derived tumor characteristics independently associated with synchronous metastatic presentation and to develop an internally validated preoperative clinical–imaging prediction model. Materials and methods: We prospectively enrolled 161 patients with colorectal cancer, including 23 (14.3%) with synchronous metastatic disease. Univariable and multivariable Firth penalized logistic regression identified independent preoperative predictors of metastatic presentation. Model performance was assessed using the area under the receiver operating characteristic curve (ROC-AUC) and internally validated by leave-one-out cross-validation (LOOCV). Secondary analyses evaluated pathological and perioperative characteristics associated with metastatic disease, while progression-free survival (PFS) was estimated using the Kaplan–Meier method. (3) Results: Patients with synchronous mCRC more frequently presented with positive MRI circumferential resection margins (mCRM), MRI-detected extramural venous invasion (mrEMVI), anterior tumor location, and tumors located <4 cm from the anal verge (all p < 0.001). In multivariable analysis, mrEMVI (adjusted OR 16.11, 95% CI 3.09–83.97; p < 0.001) and positive mCRM (adjusted OR 7.56, 95% CI 1.57–36.31; P = 0.012) remained independently associated with synchronous metastatic presentation. The parsimonious preoperative model demonstrated an apparent ROC-AUC of 0.904 and a cross-validated ROC-AUC of 0.846 (95% CI 0.706–0.961), with a Brier score of 0.063. Metastatic patients also exhibited higher rates of positive pathological circumferential resection margins, incomplete total mesorectal excision, perioperative blood transfusion, and extensive nodal involvement. Estimated PFS was 75.0% at 24 months and 41.7% at 36 months. Conclusions: Preoperative mrEMVI and positive mCRM are independent MRI biomarkers of synchronous metastatic colorectal cancer.
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