{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:58:58Z","timestamp":1790776738794,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2010only metastases to inform contemporary decision\u2010making and future trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Type<\/jats:title>\n                    <jats:p>Retrospective registry\u2010based cohort study using the TRACC registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Participants<\/jats:title>\n                    <jats:p>Consecutive patients with liver\u2010only metastatic CRC enrolled in the TRACC registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>To explore cancer biology, intended treatment at presentation, actual treatment received and the resultant outcomes for early\u2010onset CRC (EOCRC) (\u2264\u200950\u2009years) and late\u2010onset CRC (LOCRC) (&gt;\u200950\u2009years) patients with liver\u2010only metastases from a real\u2010world perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between 14 January 2009 and 2 September 2024, 1691 patients with liver\u2010only 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%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), less comorbidity (Charlson comorbidity index score 0, 90% vs. 59%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), more left\u2010sided primaries (76.1% vs. 65.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), more synchronous disease (53.3% vs. 42.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and\n                      <jats:italic>BRAF<\/jats:italic>\n                      V600E mutations (13.9% vs. 8.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). Overall, EOCRC patients had a longer median survival compared with LOCRC patients (3.20 vs. 2.38\u2009years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). For the 662 patients (39.1%) undergoing liver resection, median survival was 5.99\u2009years in EOCRC patients and 5.88\u2009years in LOCRC patients. For all patients and for those undergoing resection, respectively, B\u2010Raf proto\u2010oncogene, serine\/threonine kinase (\n                      <jats:italic>BRAF<\/jats:italic>\n                      ) (hazard ratio, 1.97 [\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001] and hazard ratio, 2.25 [\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001]) and Kirsten rat sarcoma viral oncogene homologue (\n                      <jats:italic>KRAS<\/jats:italic>\n                      ) mutations were associated with worse outcomes (hazard ratio, 1.29 [\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001] and hazard ratio, 1.34 [\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Differences in sex distribution,\n                      <jats:italic>BRAF<\/jats:italic>\n                      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\u2010only metastases.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.5694\/mja2.70266","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:59:36Z","timestamp":1787122776000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early\u2010Onset Colorectal Cancer With Liver\u2010Only Metastases: A Retrospective Cohort Study Integrating Prospectively Collected Real\u2010World Clinical and Molecular Data From an Australian National Database (2009\u20132024) to Guide Treatment Planning"],"prefix":"10.5694","volume":"224","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4999-5657","authenticated-orcid":false,"given":"Savio G.","family":"Barreto","sequence":"first","affiliation":[{"name":"Flinders Medical Centre  Adelaide South Australia Australia"},{"name":"Flinders Health and Medical Research Institute Flinders University  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos S.","family":"Karapetis","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute Flinders University  Adelaide South Australia Australia"},{"name":"Flinders Centre for Innovation in Cancer Flinders Medical Centre  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahid","family":"Ullah","sequence":"additional","affiliation":[{"name":"Flinders Health and Medical Research Institute Flinders University  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Burge","sequence":"additional","affiliation":[{"name":"Royal Brisbane and 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