Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2022; 10(8): 2429-2438
Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2429
Prognostic significance of peritoneal metastasis from colorectal cancer treated with first-line triplet chemotherapy
Shouki Bazarbashi, Abdulrahman Alghabban, Mohamed Aseafan, Ali H Aljubran, Ahmed Alzahrani, Tusneem AM Elhassan
Shouki Bazarbashi, Abdulrahman Alghabban, Mohamed Aseafan, Ali H Aljubran, Ahmed Alzahrani, Tusneem AM Elhassan, Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Riyadh, Saudi Arabia
Author contributions: Bazarbashi S contributed to designing the study; Bazarbashi S, Alghabban A and Aseafan M contributed to data analysis; Bazarbashi S, Alghabban A, Aseafan M, Aljubran AH and Alzahrani A contributed to write the manuscript; Elhassan TA has contributed to the statistical analysis.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board at King Faisal Specialist Hospital and Research Center under the number RAC2081068.
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/ct2/show/NCT01311050?term=bazarbashi&draw=2&rank=4. The registration identification number is: NCT01311050.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and since the study is not randomized trial, the CONSORT 2010 statement do not apply.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shouki Bazarbashi, MBBS, Professor, Oncology Center, King Faisal Specialist Hospital & Research Center, Alzahrawi street, Riyadh 11211, Riyadh, Saudi Arabia. bazarbashi@kfshrc.edu.sa
Received: September 16, 2021
Peer-review started: September 16, 2021
First decision: November 17, 2021
Revised: December 3, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: March 16, 2022
Abstract
BACKGROUND

Peritoneal metastasis from colorectal cancer (CRC) carries a poor prognosis in most studies. The majority of those studies used either a single-agent or doublet chemotherapy regimen in the first-line setting.

AIM

To investigate the prognostic significance of peritoneal metastasis in a cohort of patients treated with triplet chemotherapy in the first-line setting.

METHODS

We retrospectively evaluated progression-free survival (PFS) and overall survival (OS) in 51 patients with metastatic CRC treated in a prospective clinical trial with capecitabine, oxaliplatin, irinotecan, and bevacizumab in the first-line setting according to the presence and absence of peritoneal metastasis. Furthermore, univariate and multivariate analyses for PFS and OS were performed to assess the prognostic significance of peritoneal metastasis at the multivariate level.

RESULTS

Fifty-one patients were treated with the above triplet therapy. Fifteen had peritoneal metastasis. The patient characteristics of both groups showed a significant difference in the sidedness of the primary tumor (left-sided primary tumor in 60% of the peritoneal group vs 86% in the nonperitoneal group, P = 0.03) and the presence of liver metastasis (40% for the peritoneal group vs 75% for the nonperitoneal group, P = 0.01). Univariate analysis for PFS showed a statistically significant difference for age less than 65 years (P = 0.034), presence of liver metastasis (P = 0.046), lung metastasis (P = 0.011), and those who underwent metastasectomy (P = 0.001). Only liver metastasis and metastasectomy were statistically significant for OS, with P values of 0.001 and 0.002, respectively. Multivariate analysis showed that age (less than 65 years) and metastasectomy were statistically significant for PFS, with P values of 0.002 and 0.001, respectively. On the other hand, the absence of liver metastasis and metastasectomy were statistically significant for OS, with P values of 0.003 and 0.005, respectively.

CONCLUSION

Peritoneal metastasis in patients with metastatic CRC treated with first-line triple chemotherapy does not carry prognostic significance at univariate and multivariate levels. Confirmatory larger studies are warranted.

Keywords: Colorectal cancer, Peritoneal carcinomatosis, Triplet chemotherapy, Survival, Prognostic factors, Metastasectomy

Core Tip: The established poor prognostic indicator of peritoneal metastasis in metastatic colorectal cancer (CRC) has been in patients treated with single agent or doublet chemotherapy. In our study, we retrospectively demonstrated that in patients treated with triplet chemotherapy in the first-line setting, the significance of peritoneal metastasis as a poor prognostic factor was lost. This might suggest a beneficial therapeutic effect of triplet chemotherapy in the first-line setting in patients with metastatic CRC and peritoneal metastasis.