A French population-based cohort spanning 2004–2021 zooms in on metastatic patterns in colorectal adenocarcinoma revealing a sharp relative risk in for multiple-site metastases (MSM), increasing ~9–10% annually in those aged 15–39. Even more specifically, the rise was largely explained by a 6-fold increase in rates of peritoneal metastases at presentation among younger patients. This is noteworthy because, while overall survival for de novo metastatic disease improved significantly over the two decades analysed, not so for peritoneal disease with persistently poor survival at three years (<30%). Unfortunately, this isn’t terribly actionable other than ensuring a sharp eye for peritoneal mets on initial staging for young patients and, when identified, considering earlier escalation of systemic therapy and/or a clinical trial. | Jooste, JAMA Netw Open 2026
