Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3668
Peer-review started: December 4, 2020
First decision: January 25, 2021
Revised: February 6, 2021
Accepted: March 18, 2021
Article in press: March 18, 2021
Published online: May 26, 2021
Processing time: 158 Days and 1.1 Hours
Metachronous pulmonary and pancreatic metastases from colorectal cancer are rare. The diagnosis of pancreatic metastases is difficult and predominantly relies on computed tomography, pathology and immunohistochemistry. Here, we describe the use of next-generation sequencing (NGS) for determination of the origin of metastasis and prognostic prediction of colorectal cancer.
A 59-year-old man was diagnosed with sigmoid adenocarcinoma stage IIA (T3N0M0) and underwent surgery in April 2014, followed by XELOX adjuvant chemotherapy. The patient developed pulmonary metastasis in the right upper lung and underwent surgery in May 2016 without further adjuvant chemotherapy. In May 2018, pancreatic metastasis was found and he underwent pancreaticoduodenectomy. After surgery, he was treated with adjuvant S-1 chemotherapy from June 2018 to March 2019. Histopathological review of the specimens from all three lesions indicated consistent patterns characteristic of colon cancer. Concordant gene mutation profiles were observed across the three lesions that included oncogenic driver mutations most frequently seen in colon cancer (e.g., APC, TP53, KRAS and FBXW7). Blood circulating tumor (ct)DNA before adjuvant chemotherapy was undetectable with NGS, suggesting a favorable response to chemotherapy. The patient was alive and well at the latest follow-up visit, achieving a disease-free survival of 17 mo.
The genetic profiles of primary tumor, metastases and ctDNA may have clinical value in auxiliary diagnosis, prognosis and therapeutic decision-making.
Core Tip: We describe a rare case of metachronous pulmonary and pancreatic metastases from colorectal cancer. Immunohistochemistry and next-generation sequencing (NGS) results suggested that pancreatic and pulmonary metastases both originated from the primary colon cancer. To our knowledge, this is the first case to utilize NGS to detect the origin of pancreatic metastasis from colon cancer. NGS also provided useful information for predicting clinical outcome and therapeutic decision-making.