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Vu JK, Brown KGM, Solomon MJ, Ng KS, Mahon K, Le BK, Sutherland S, Lee PJ, Byrne CM, Austin KKS, Steffens D. Oligometastatic Disease Is Not an Absolute Contraindication to Pelvic Exenteration in Selected Patients With Locally Recurrent Rectal Cancer. Dis Colon Rectum 2025; 68:408-416. [PMID: 39727315 DOI: 10.1097/dcr.0000000000003613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Abstract
BACKGROUND The treatment of locally recurrent rectal cancer has evolved dramatically in recent decades. As the boundaries of exenterative surgery continue to be pushed, one of the unanswered and controversial questions is the role of radical salvage surgery for locally recurrent rectal cancer in the setting of oligometastatic disease. OBJECTIVE To investigate the impact of synchronous or previously treated distant metastases on survival after pelvic exenteration for locally recurrent rectal cancer. DESIGN Retrospective analysis of a prospectively maintained database. SETTINGS A high-volume specialist exenteration center. PATIENTS Consecutive adult patients undergoing pelvic exenteration with curative intent for locally recurrent rectal cancer between 1994 and 2023. MAIN OUTCOME MEASURES Overall survival from time of pelvic exenteration. RESULTS Of the 300 patients included, 193 (64%) were men, and the median age at the time of pelvic exenteration was 62 years (range, 29-86). The median time from primary rectal cancer surgery to pelvic exenteration was 35 months (range, 4-191). In total, 56 patients (19%) had a history of metastatic disease, of whom 42 (14%) had previously treated metastases and 18 patients (6%) had synchronous metastatic disease (including 4 patients with both synchronous and previously treated metastases). Five-year overall survival rate and median overall survival was 41% and 45 months, respectively. There was a trend toward poorer 5-year overall survival in patients with a history of metastatic disease compared to those without (25% vs 45%); however, this did not reach statistical significance ( p = 0.110), possibly due to a lack of statistical power. Five-year overall survival was 27%, 25%, and 45% for patients with synchronous metastases, previously treated metastases, and no history of metastases, respectively ( p = 0.260). LIMITATIONS Findings may not be applicable beyond highly selected patients treated at specialized exenteration centers. CONCLUSIONS Long-term survival is achievable in highly selected patients with locally recurrent rectal cancer and synchronous or previously treated distant metastases. Therefore, oligometastatic disease should not be considered an absolute contraindication to exenterative surgery. See Video Abstract . LA ENFERMEDAD OLIGOMETASTSICA NO ES UNA CONTRAINDICACIN ABSOLUTA PARA LA EXENTERACIN PLVICA EN PACIENTES SELECCIONADOS CON CNCER RECTAL LOCALMENTE RECURRENTE ANTECEDENTES:El tratamiento del cáncer rectal localmente recurrente ha evolucionado drásticamente en las últimas décadas. A medida que se siguen ampliando los límites de la cirugía exenterativa, una de las preguntas sin respuesta y controvertidas es el papel de la cirugía radical de rescate para el cáncer rectal localmente recurrente en el contexto de la enfermedad oligometastásica.OBJETIVO:Investigar el impacto de las metástasis distantes sincrónicas o tratadas previamente en la supervivencia después de la exenteración pélvica para el cáncer rectal localmente recurrente.DISEÑO:Análisis retrospectivo de una base de datos mantenida prospectivamente.ESTABLECIMIENTO:Un centro de exenteración especializado de alto volumen.PACIENTES:Pacientes adultos consecutivos sometidos a exenteración pélvica con intención curativa para cáncer rectal localmente recurrente entre 1994 y 2023.PRINCIPALES MEDIDAS DE RESULTADOS:Supervivencia general desde el momento de la exenteración pélvica.RESULTADOS:De los 300 pacientes incluidos, 193 (64%) eran varones y la edad media fue de 62 años (rango 29-86). La mediana de tiempo desde la cirugía del cáncer rectal primario hasta la exenteración pélvica fue de 35 meses (rango 4-191). En total, 56 pacientes (19%) tenían antecedentes de enfermedad metastásica; de los cuales 42 (14%) habían sido tratados por metástasis previamente y 18 pacientes (6%) tenían enfermedad metastásica sincrónica (incluidos 4 pacientes con metástasis tanto sincrónicas como tratadas previamente). La supervivencia global a 5 años y la mediana de supervivencia global fueron del 41% y 45 meses, respectivamente. Hubo una tendencia hacia una peor supervivencia global a 5 años en pacientes con antecedentes de enfermedad metastásica en comparación con los que no la tenían (25% frente a 45%); sin embargo, esto no alcanzó la significación estadística ( p = 0,110), posiblemente debido a la falta de poder estadístico. La supervivencia global a los 5 años fue del 27%, 25% y 45% para los pacientes con metástasis sincrónicas, metástasis tratadas previamente y sin antecedentes de metástasis, respectivamente ( p = 0,260).LIMITACIONES:Los hallazgos pueden no ser aplicables más allá de pacientes altamente seleccionados tratados en centros de exenteración especializados.CONCLUSIONES:La supervivencia a largo plazo es alcanzable en pacientes altamente seleccionados con cáncer rectal localmente recurrente y metástasis distantes sincrónicas o tratadas previamente. Por lo tanto, la enfermedad oligometastásica no debe considerarse una contraindicación absoluta para la cirugía de exenteración. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Jennifer K Vu
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kilian G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate Mahon
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Bernard K Le
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Sutherland
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Peter J Lee
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kirk K S Austin
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Marcinak CT, Schwartz PB, Basree MM, Hurst N, Bassetti M, Kratz JD, Uboha NV. Treatment of Oligometastatic GI Cancers. Am Soc Clin Oncol Educ Book 2024; 44:e430152. [PMID: 38190577 DOI: 10.1200/edbk_430152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Oligometastatic state is believed to potentially represent a transitional stage between early, locoregional state disease and widely metastatic disease. Historically, locoregional approaches, particularly in advanced colorectal cancers, have demonstrated efficacy in select patients with limited burden of metastatic disease. Recent strides in systemic therapies, including biomarker-based treatments and immunotherapy, alongside innovations in surgical techniques and novel locoregional approaches such as stereotactic radiotherapy and ablation, have ushered in a new era of therapeutic possibilities across all oligometastatic GI cancers. Despite these advancements, there remains a significant gap in high-quality prospective evidence guiding patient selection and treatment decisions across various disease types. Ongoing clinical trials are anticipated to provide crucial insights into oligometastatic states, fostering the refinement of disease-specific oligometastatic state definitions and treatment algorithms. This article reviews existing data on the management of oligometastatic GI cancer, summarizes current state of knowledge for each disease state, and provides updates on ongoing studies in this space.
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Affiliation(s)
- Clayton T Marcinak
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Patrick B Schwartz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Mustafa M Basree
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Newton Hurst
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Jeremy D Kratz
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
- Center for Human Genomics and Precision Medicine, University of Wisconsin, Madison, WI
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nataliya V Uboha
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
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Yokoi R, Tajima JY, Fukada M, Hayashi H, Kuno M, Asai R, Sato Y, Yasufuku I, Kiyama S, Tanaka Y, Murase K, Matsuhashi N. Optimizing Treatment Strategy for Oligometastases/Oligo-Recurrence of Colorectal Cancer. Cancers (Basel) 2023; 16:142. [PMID: 38201569 PMCID: PMC10777959 DOI: 10.3390/cancers16010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer, and nearly half of CRC patients experience metastases. Oligometastatic CRC represents a distinct clinical state characterized by limited metastatic involvement, demonstrating a less aggressive nature and potentially improved survival with multidisciplinary treatment. However, the varied clinical scenarios giving rise to oligometastases necessitate a precise definition, considering primary tumor status and oncological factors, to optimize treatment strategies. This review delineates the concepts of oligometastatic CRC, encompassing oligo-recurrence, where the primary tumor is under control, resulting in a more favorable prognosis. A comprehensive examination of multidisciplinary treatment with local treatments and systemic therapy is provided. The overarching objective in managing oligometastatic CRC is the complete eradication of metastases, offering prospects of a cure. Essential to this management approach are local treatments, with surgical resection serving as the standard of care. Percutaneous ablation and stereotactic body radiotherapy present less invasive alternatives for lesions unsuitable for surgery, demonstrating efficacy in select cases. Perioperative systemic therapy, aiming to control micrometastatic disease and enhance local treatment effectiveness, has shown improvements in progression-free survival through clinical trials. However, the extension of overall survival remains variable. The review emphasizes the need for further prospective trials to establish a cohesive definition and an optimized treatment strategy for oligometastatic CRC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Gifu, Japan; (R.Y.); (K.M.)
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Miller ED, Hitchcock KE, Romesser PB. Oligometastatic Colorectal Cancer: A Review of Definitions and Patient Selection for Local Therapies. J Gastrointest Cancer 2023; 54:1116-1127. [PMID: 36652155 PMCID: PMC10352468 DOI: 10.1007/s12029-022-00900-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Nearly one-third of patients diagnosed with colorectal cancer (CRC) will ultimately develop metastatic disease. While a small percentage of patients can be considered for curative resection, more patients have limited disease that can be considered for local therapy. Challenges remain in defining oligometastatic CRC as well as developing treatment strategies guided by high level evidence. METHODS In this review, we present the challenges in defining oligometastatic CRC and summarize the current literature on treatment and outcomes of local therapy in patients with metastatic CRC. RESULTS For patients with liver- and/or lung-confined CRC metastases, surgical resection is the standard of care given the potential for long-term progression-free and overall survival. For patients with liver- or lung-confined disease not amenable to surgical resection, non-surgical local therapies, such as thermal ablation, hepatic arterial infusion pump (HAIP), or stereotactic body radiation therapy (SBRT), should be considered. For patients with more advanced disease, such as lymph node or bony metastases, the role of metastasis-directed therapy is controversial. Emerging data suggests that SBRT to ablate all metastases can improve progression-free and overall survival. CONCLUSION Multidisciplinary management is critical for patients with metastatic CRC due to the complexity of their cases and the nuanced patient, tumor, biological, and anatomical factors that must be weighed when considering local therapy. High-quality prospective randomized data in CRC are needed to further clarify the role of local ablative therapy in patients with unresectable oligometastatic CRC with ongoing studies including the RESOLUTE trial (ACTRN12621001198819) and the upcoming NCTN ERASur trial (NCT05673148).
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Affiliation(s)
- Eric D Miller
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, 460 W. 10Th Ave., Room A209, Columbus, OH, 43210, USA.
| | - Kathryn E Hitchcock
- Department of Radiation Oncology, University of Florida Health, Gainesville, FL, USA
| | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Fernández Montes A, Alonso V, Aranda E, Élez E, García Alfonso P, Grávalos C, Maurel J, Vera R, Vidal R, Aparicio J. SEOM-GEMCAD-TTD clinical guidelines for the systemic treatment of metastatic colorectal cancer (2022). Clin Transl Oncol 2023; 25:2718-2731. [PMID: 37133732 PMCID: PMC10425293 DOI: 10.1007/s12094-023-03199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer deaths in Spain. Metastatic disease is present in 15-30% of patients at diagnosis and up to 20-50% of those with initially localized disease eventually develop metastases. Recent scientific knowledge acknowledges that this is a clinically and biologically heterogeneous disease. As treatment options increase, prognosis for individuals with metastatic disease has steadily improved over recent decades. Disease management should be discussed among experienced, multidisciplinary teams to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures, when indicated. Clinical presentation, tumor sidedness, molecular profile, disease extension, comorbidities, and patient preferences are key factors when designing a customized treatment plan. These guidelines seek to provide succinct recommendations for managing metastatic CRC.
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Affiliation(s)
- Ana Fernández Montes
- Medical Oncology Department, Complexo Hospitalario Universitario, Ourense (CHUO), C/ Ramón Puga, 56, 32005, Ourense, Spain.
| | - Vicente Alonso
- Medical Oncology Department, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Enrique Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena Élez
- Medical Oncology Department, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Pilar García Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joan Maurel
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Ruth Vera
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Rosario Vidal
- Medical Oncology Department, Complejo Asistencial Universitario, Salamanca, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitari I Politècnic la Fe, Valencia, Spain
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Tseng CW, Teng HW, Lin CC, Lei HJ, Hung JJ, Liang WY, Hsia CY, Chou SC, Lin HH, Huang SC, Cheng HH, Lan YT, Wang HS, Yang SH, Chen WS, Lin JK, Jiang JK, Chang SC, Chau GY. Surgical strategy for colorectal cancer with synchronous liver and extrahepatic metastases: A scoring system and decision tree model. J Chin Med Assoc 2023; 86:732-739. [PMID: 37294150 DOI: 10.1097/jcma.0000000000000947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The role of hepatectomy in a specific group of patients with synchronous colorectal cancer with liver metastases (SCRLM) and synchronous extrahepatic disease (SEHD) is still unclear. The aim of this study was to evaluate the efficacy of liver surgery and define the selection criteria for surgical candidates in patients with SCRLM + SEHD. METHODS Between July 2007 and October 2018, 475 patients with colorectal cancer with liver metastases (CRLM) who underwent liver resection were retrospectively reviewed. Sixty-five patients with SCRLM + SEHD were identified and included in the study. Clinical pathological data of these patients were analyzed to evaluate the influence on survival. Important prognostic factors were identified by univariate and multivariate analyses. The risk score system and decision tree analysis were generated according to the important prognostic factors for better patient selection. RESULTS The 5-year survival rate of patients with SCRLM + SEHD was 21.9%. The most important prognostic factors were SCRLM number of more than five, site of SEHD other than the lung only, inability to achieve SCRLM + SEHD R0 resection, and BRAF mutation of cancer cells. The proposed risk score system and decision tree model easily discriminated between patients with different survival rates and identified the profile of suitable surgical patients. CONCLUSION Liver surgery should not be a contraindication for patients with SCRLM + SEHD. Patients with complete SCRLM + SEHD R0 resection, SCRLM number less than or equal to five, SEHD confined to the lung only, and wild-type BRAF could have favorable survival outcomes. The proposed scoring system and decision tree model may be beneficial to patient selection in clinical use.
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Affiliation(s)
- Chan-Wei Tseng
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Wei Teng
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chun-Chi Lin
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Jan Lei
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jung-Jyh Hung
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Yih Liang
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Yuan Hsia
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Cheng Chou
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hung-Hsin Lin
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Sheng-Chieh Huang
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hou-Hsuan Cheng
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yuan-Tzu Lan
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Huann-Sheng Wang
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shung-Haur Yang
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Shone Chen
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jen-Kou Lin
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jeng-Kai Jiang
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Ching Chang
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Gar-Yang Chau
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Lillemoe HA, Passot G, Kawaguchi Y, DeBellis M, Glehen O, Chun YS, Tzeng CWD, Aloia TA, Lopez J, Vauthey JN. RAS/TP53 Co-mutation is Associated With Worse Survival After Concurrent Resection of Colorectal Liver Metastases and Extrahepatic Disease. Ann Surg 2022; 276:357-362. [PMID: 33351476 PMCID: PMC11992627 DOI: 10.1097/sla.0000000000004672] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if tumor genetics are associated with overall survival (OS) after concurrent resection of colorectal liver metastases (CLM) and extrahepatic disease (EHD). SUMMARY BACKGROUND DATA The prognosis for patients who undergo concurrent resection of CLM/EHD is unclear and the impact of somatic mutations has not been reported. METHODS Patients undergoing concurrent resection of CLM and EHD from 2007 to 2017 were identified from 2 academic centers. From 1 center, patients were selected from a pre-existing database of patients undergoing cytore-ductive surgery with hyperthermic intraperitoneal chemotherapy. The Kaplan-Meier method was used to construct survival curves, compared using the log-rank test. Multivariable Cox analysis for OS was performed. RESULTS One hundred nine patients were included. Most common EHD sites included lung (33 patients), peritoneum (32), and portal lymph nodes (14). TP53 mutation was the most common mutation, identified in 75 patients (69%), and RAS/TP53 co-mutation was identified in 31 patients (28%). The median OS was 49 months (interquartile range, 24-125), and 3- and 5-year OS rates were 66% and 44%, respectively. Compared to patients without RAS/ TP53 co-mutation, patients with RAS/TP53 co-mutation had lower median OS: 39 vs. 51 months ( P = 0.02). On multivariable analysis, lung EHD [hazard ratio (HR), 0.7; 95% confidence intervals (CI), 0.3-1.4], peritoneal EHD (HR, 2.2; 95% CI, 1.1-4.2) and RAS/TP53 co-mutation (HR, 2.8; 95% CI, 1.1-7.2) were independently associated with OS. CONCLUSIONS RAS/TP53 co-mutation is associated with worse OS after concurrent CLM/EHD resection. Mutational status and site of EHD should be included in the evaluation of patients considered for concurrent resection.
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Affiliation(s)
- Heather A. Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guillaume Passot
- Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EMR 3738, CICLY, Université Claude Bernard Lyon 1, Lyon, France
| | - Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario DeBellis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Olivier Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EMR 3738, CICLY, Université Claude Bernard Lyon 1, Lyon, France
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Thomas A. Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan Lopez
- Cancer Research Center of Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France / Department of Biochemistry and Molecular Biology, Lyon University Hospital, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Jethwa KR, Jin Z, Hallemeier CL. A Critical Review of the Role of Local Therapy for Oligometastatic Gastrointestinal Cancer. Int J Radiat Oncol Biol Phys 2022; 114:780-791. [DOI: 10.1016/j.ijrobp.2022.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 10/31/2022]
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Is Surgical Treatment Effective or Contraindicated in Patients with Colorectal Cancer Liver Metastases Exhibiting Extrahepatic Metastasis? J Gastrointest Surg 2022; 26:594-601. [PMID: 34506021 DOI: 10.1007/s11605-021-05122-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical resection for patients with hepatic and extrahepatic colorectal metastases remains controversial. This study aimed to determine the efficacy of curative resection of distant extrahepatic metastatic lesions in patients with colorectal liver metastases (CRLM). METHODS From 2007 to 2019, 377 patients with CRLM were treated; of these, 323 patients underwent hepatectomy, and 54 patients with extrahepatic metastases (EHM) had received only chemotherapy. Survival and recurrence were compared between patients with and without EHM. Variables potentially associated with survival were analyzed in univariate and multivariate analyses. RESULTS Among patients who underwent hepatectomy, the median, 3-, and 5-year overall survival rates for patients with EHM (n = 60) were 32 months, 47%, and 28%, respectively, while those for patients without EHM (n = 263) were 115 months, 79%, and 66%, respectively (p < 0.001). Furthermore, outcomes were similar in R2 patients with EHM and those with unresectable tumors. However, outcomes were significantly better in the R0/1 group than in the R2 and unresectable groups (p < 0.001). Among patients with EHM, multivariate analysis revealed that higher clinical risk score, incomplete resection of all EHM, extrahepatic disease detected intraoperatively, and previous treatment with neoadjuvant chemotherapy were independently associated with worse survival. CONCLUSIONS In patients with CRLM with EHM (liver + one organ), gross curative resection is necessary when surgical treatment is contemplated, and resection of liver metastases should be performed in patients with CRLM with smaller and fewer tumors (e.g., H1).
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10
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Lin YM, Paolucci I, Brock KK, Odisio BC. Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward. Cancers (Basel) 2021; 13:3926. [PMID: 34439081 PMCID: PMC8394430 DOI: 10.3390/cancers13163926] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Iwan Paolucci
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Kristy K. Brock
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bruno C. Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
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11
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Protic M, Krsmanovic O, Solajic N, Kukic B, Nikolic I, Bogdanovic B, Radovanovic Z, Kresoja M, Mannion C, Man YG, Stojadinovic A. Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases. J Cancer 2021; 12:3701-3714. [PMID: 33995645 PMCID: PMC8120181 DOI: 10.7150/jca.58580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/19/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: More than 50% of patients with colorectal cancer (CRC) develop liver metastases during the natural course of disease. Surgical resection is currently the most potentially curative method in the treatment of colorectal liver metastases (CRLM). The goal of surgery is to achieve a negative resection margin (RM) of at least 1 mm, which provides the best prognosis for patients. The RM can be assessed by the pathologist of the resected liver specimen (RLS) and by the surgeon intraoperatively. The aim of this research paper is to determine the degree of agreement on intraoperative assessment of the RM by the surgeon and histopathological RM assessment by the pathologist. Material and methods: This prospective non-randomized double-blind study was approved by the Ethics Committee of the Oncology Institute of Vojvodina and registered on ClinicalTrials.gov #NCT04634526. The study was conducted at the Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. An experienced hepatobiliary surgeon assessed RM for every specimen intra-operatively, immediately after CRLM resection. Resected CRLM lesions were analyzed by two experienced pathologists. These data were compared with pathological RM assessment as a “gold standard”. RM of 1 mm or more was rated as negative RM (RM-). Disease-free survival (DFS) and recurrence rate was calculated by RM status defined by surgeon and by pathologist. Results: From 01 January 2015 to 31 August 2019, 98 patients were enrolled in the study. There were 219 RLS with 245 CRLM. The surgeon registered positive RM (RM+) of <1mm in 41 (18.7%) RLS. Taking the result of the histopathological assessment (HPA) as the “gold standard”, it was determined that RM was true positive in 32 (14.6%) cases. False positive RM was found in 9 (4.1%) cases. False negative RM was found in 20 (9.1%) cases. True negative RM was found in 158 (72.2%) cases. Sensitivity of surgical assessment (SA) of RM+ was 61.5% (32/52). Specificity of SA of RM+ was 94.6% (158/167). The positive predictive value (PPV) was 78.0% (32/41), while the negative predictive value (NPV) was 88.8% (158/178). The overall accuracy of the RM+ SA was 86.8% (190/219). There was no statistically significant difference in the assessment of RM+ per RLS by surgeon and pathologists (p=0.061), but it was significant when analyses per patients was performed (p=0.017). Recurrence rate for RM+ patients was 48.1% (13/27, p=0.05) for SA and 35.0% (14/40, p=0.17) for HPA. Three year DFS for RM- and RM+ was 66.5% and 27.9% (p=0.04), respectively, by SA, and 64.8% and 42.1% (p=0.106), respectively, by HPA. Conclusion: Intraoperative assessment of RM- by surgeon of RLS is clinically meaningful. There is not a statistically significant difference in the assessment of RM+ by surgeon and pathologists per RLS, but it was statically significant on a per patient basis. RM determined by surgeon has better prognostic impact on recurrence rate and 1- and 3-year DFS than standard histopathological assessment.
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Affiliation(s)
- Mladjan Protic
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Olivera Krsmanovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Armed Forces of Bosnia and Herzegovina, Logistics Command, Doboj, Bosnia and Herzegovina
| | - Nenad Solajic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department of Pathoanatomical and Laboratory Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Biljana Kukic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Clinic for Internal Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Ivan Nikolic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Clinic for Internal Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Bogdan Bogdanovic
- Clinic for Internal Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Zoran Radovanovic
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Milana Kresoja
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ciaran Mannion
- Department of Pathology, Hackensack University Medical Center, Hackensack, New Jersey, USA.,Department of Pathology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Yan-Gao Man
- Department of Pathology, Hackensack University Medical Center, Hackensack, New Jersey, USA
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12
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Abstract
Liver metastases are commonly detected in a range of malignancies including colorectal cancer (CRC), pancreatic cancer, melanoma, lung cancer and breast cancer, although CRC is the most common primary cancer that metastasizes to the liver. Interactions between tumour cells and the tumour microenvironment play an important part in the engraftment, survival and progression of the metastases. Various cells including liver sinusoidal endothelial cells, Kupffer cells, hepatic stellate cells, parenchymal hepatocytes, dendritic cells, resident natural killer cells as well as other immune cells such as monocytes, macrophages and neutrophils are implicated in promoting and sustaining metastases in the liver. Four key phases (microvascular, pre-angiogenic, angiogenic and growth phases) have been identified in the process of liver metastasis. Imaging modalities such as ultrasonography, CT, MRI and PET scans are typically used for the diagnosis of liver metastases. Surgical resection remains the main potentially curative treatment among patients with resectable liver metastases. The role of liver transplantation in the management of liver metastasis remains controversial. Systemic therapies, newer biologic agents (for example, bevacizumab and cetuximab) and immunotherapeutic agents have revolutionized the treatment options for liver metastases. Moving forward, incorporation of genetic tests can provide more accurate information to guide clinical decision-making and predict prognosis among patients with liver metastases.
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13
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Prasanna T, Wong R, Price T, Shapiro J, Tie J, Wong HL, Nott L, Roder D, Lee M, Kosmider S, Jalali A, Burge M, Padbury R, Maddern G, Carruthers S, Moore J, Sorich M, Karapetis CS, Gibbs P, Yip D. Metastasectomy and BRAF mutation; an analysis of survival outcome in metastatic colorectal cancer. Curr Probl Cancer 2021; 45:100637. [PMID: 32826083 DOI: 10.1016/j.currproblcancer.2020.100637] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether the benefit is consistent for BRAF V600E mutant (MT) and wild type (WT) mCRC. This retrospective analysis explores the influence of BRAF MT on survival after metastasectomy. METHODS Overall survival (OS) and recurrence-free survival (RFS) for BRAF MT and WT mCRC were evaluated. Survival was also analyzed in the cohort of BRAF MT with or without metastasectomy. RESULTS Five hundred and thirteen patients who had undergone metastasectomy were identified, 6% were BRAF-MT. Median age 63. Median OS in BRAF MT vs WT: 25.7 vs 48.5 months (hazard ratio [HR] 1.95; 1.18-3.22). However, difference was not significant in a multivariate model. Right primary tumor, intact primary, >1 metastatic site, non-R0 resection, peritoneal metastasis, and synchronous metastasis were independent predictors of worse OS. Among 364 patients with RFS data there was no difference between BRAF MT and WT (16 vs 19 months, p=0.09). In another cohort of 158 BRAF-MT patients, OS was significantly better after metastasectomy compared to "no metastasectomy" (HR 0.34; 0.18-0.65, P= 0.001). Proficient mismatch repair status showed a trend toward worse survival after metastasectomy in BRAF MT (HR 1.71, P = 0.08). CONCLUSION OS did not differ after metastasectomy between BRAF MT and WT in a multivariate model. Median OS was >2 years in this study after metastasectomy among BRAFV600E MT patients suggesting a survival benefit of metastasectomy in this group where systemic therapeutic options are limited. Metastasectomy may be considered in carefully selected BRAF-MT patients.
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Affiliation(s)
- Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Australia; University of Canberra, ACT, Australia.
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia; Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Timothy Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Australia
| | - Jeanne Tie
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Hui-Li Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia; Menzies Research institute, Hobart, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Australia; University of South Australia, Adelaide, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - Suzanne Kosmider
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
| | - Azim Jalali
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia
| | - Matthew Burge
- Department of Medical Oncology, Royal Brisbane Hospital, Brisbane, Australia
| | - Robert Padbury
- Flinders University, Bedford Park, Australia; Department of Surgery, Flinders Medical Centre, Australia
| | - Guy Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Scott Carruthers
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - James Moore
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Christos S Karapetis
- Flinders University, Bedford Park, Australia; Department of Medical Oncology, Flinders Medical Centre, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Australia
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14
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Dixon MEB, Gusani NJ. Bilobar Colorectal Liver Metastases: Challenges and Opportunities. Ann Surg Oncol 2021; 28:1268-1270. [PMID: 33393022 DOI: 10.1245/s10434-020-09468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Matthew E B Dixon
- Program for Liver, Pancreas, and Foregut Tumors, Division of Surgical Oncology, Penn State College of Medicine, Hershey, PA, USA
| | - Niraj J Gusani
- Section of Surgical Oncology, Baptist MD Anderson Cancer Center, Jacksonville, FL, USA.
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15
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Serrano PE, Gu CS, Moulton CA, Gallinger S. Positron Emission Tomography Combined With Computed Tomography vs. No Positron Emission Tomography Combined With Computed Tomography for the Management of Patients With Resectable Colorectal Cancer Liver Metastases and Synchronous Extrahepatic Disease. Am Surg 2020; 87:1431-1437. [PMID: 33345573 DOI: 10.1177/0003134820954834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Selected patients with colorectal cancer liver metastases (CRLM) and synchronous extrahepatic disease (EHD) are considered for surgery. OBJECTIVES To evaluate the change in surgical management and long-term survival (disease-free survival [DFS] and overall survival [OS]) for patients with CRLM and EHD who undergo positron emission tomography combined with computed tomography (PET-CT) vs no PET-CT. METHODS Patients with CRLM were enrolled in a trial evaluating the effect of PET-CT (vs no PET-CT) on surgical management, DFS, and OS. This is a sub-study of the trial, including only patients with synchronous EHD. Cox proportional hazard models were used to calculate risks for recurrence and death. Survival were described by Kaplan-Meier method and compared with log-rank test. RESULTS Of 25 patients with EHD (PET-CT arm: 14/270 (5%) and no PET-CT arm: 11/134 (8%)), PET-CT changed surgical management in 14%, all of which avoided liver resection due to more extensive disease. Complete metastasectomy was achieved in 36% (5/14) and 72% (8/11), respectively. Respectively, PET-CT vs no PET-CT had statistically similar median DFS, 5.6 months (95% confidence interval (CI) 3.6-18) vs 7.6 months (95% CI 2.9-15) and median OS, 42 months (95% CI 25-48) vs 29 months (95% CI 17-41). EHD was associated with worse DFS (hazard ratio HR = 1.89, 95% CI 1.41-2.52) and OS (HR = 2.47, 95% CI 1.6-3.83). CONCLUSIONS Preoperative PET-CT for the management of resectable CRLM did not improve long-term outcomes among patients who had synchronous EHD; however, it changed surgical management in a relatively significant proportion of patients.
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Affiliation(s)
- Pablo E Serrano
- Department of Surgery, 153004McMaster University, Canada.,Ontario Clinical Oncology Group, McMaster University, Canada
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Canada.,Department of Oncology, 152999McMaster University, Canada
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16
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Lang H. Liver resection is beneficial for patients with colorectal liver metastases and extrahepatic disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1122. [PMID: 33240971 PMCID: PMC7576061 DOI: 10.21037/atm-20-4416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Medical Center, Mainz, Germany
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17
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Sawada Y, Sahara K, Endo I, Sakamoto K, Honda G, Beppu T, Kotake K, Yamamoto M, Takahashi K, Hasegawa K, Itabashi M, Hashiguchi Y, Kotera Y, Kobayashi S, Yamaguchi T, Tabuchi K, Kobayashi H, Yamaguchi K, Morita S, Natsume S, Miyazaki M, Sugihara K. Long-term outcome of liver resection for colorectal metastases in the presence of extrahepatic disease: A multi-institutional Japanese study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:810-818. [PMID: 32713080 DOI: 10.1002/jhbp.810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE The purpose of the present study was to assess long-term outcomes following liver resection for colorectal liver metastases (CRLM) with concurrent extrahepatic disease and to identify the preoperative prognostic factors for selection of operative candidates. METHODS In this retrospective, multi-institutional study, 3820 patients diagnosed with CRLM during 2005-2007 were identified using nationwide survey data. Data of identified patients with concurrent extrahepatic lesions were analyzed to estimate the impact of liver resection on overall survival (OS) and to identify preoperative, prognostic indicators. RESULTS Three- and 5-year OS rates after liver resection in 251 CRLM patients with extrahepatic disease (lung, n = 116; lymph node, n = 51; peritoneal, n = 37; multiple sites, n = 23) were 50.2% and 32.0%, respectively. Multivariate analysis revealed that a primary tumor in the right colon, lymph node metastasis from the primary tumor, serum carbohydrate antigen (CA) 19-9 level >37 UI/mL, the site of extrahepatic disease, and residual liver tumor after hepatectomy were associated with higher mortality. We proposed a preoperative risk scoring system based on these factors that adequately discriminated 5-year OS after liver resection in training and validation datasets. CONCLUSIONS Performing R0 liver resection for colorectal liver metastases with treatable extrahepatic disease may prolong survival. Our proposed scoring system may help select appropriate candidates for liver resection.
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Affiliation(s)
- Yu Sawada
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Kota Sahara
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Itaru Endo
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Katsunori Sakamoto
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Goro Honda
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Toru Beppu
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, Japan
| | - Kenjiro Kotake
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Sano City Hospital, Sano, Tochigi, Japan
| | - Masakazu Yamamoto
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Keiichi Takahashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Michio Itabashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yojiro Hashiguchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yoshihito Kotera
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Shin Kobayashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa-shi, Chiba, Japan
| | - Tatsuro Yamaguchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Ken Tabuchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Pediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hirotoshi Kobayashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Kensei Yamaguchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Satoshi Morita
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Japan
| | - Soichiro Natsume
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis, Tokyo, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masaru Miyazaki
- International University of Health and Welfare, Mita Hospital, Minato-ku, Tokyo, Japan
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18
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Alese OB, Zakka K, Huo X, Jiang R, Shaib WL, Akce M, Behera M, Sullivan P, Wu C, El-Rayes BF. Perioperative therapy in metastatic colorectal cancer: Pattern of use and survival outcomes. J Surg Oncol 2020; 123:596-605. [PMID: 33125756 DOI: 10.1002/jso.26278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multimodality therapy of metastatic colorectal cancer (mCRC) is currently considered the standard of care. The aim of this study was to evaluate the impact of perioperative therapy on surgical resection in mCRC. METHODS The National Cancer Database was analyzed for affected patients between 2004 and 2013. Univariate and multivariate analyses were done to identify factors associated with patient outcomes. Kaplan-Meier analysis and Cox proportional hazards models were used for the association between patient characteristics and survival. RESULTS About 61,940 patients with mCRC were identified. Mean age = 63.4 years (SD ± 14). About 69% had a colon primary and 32% had only one metastatic site. Only 49% of those who underwent surgery for both primary and metastatic sites received postoperative chemotherapy (p < .001). Negative prognostic factors included no chemotherapy received (hazard ratio [HR], 2.32; 2.27-2.37; p < .001), more than three metastatic sites (HR, 2.28; 2.09-2.48; p < .001), year of diagnosis between 2004 and 2008 (HR, 1.71; 1.15-1.20; p < .001) and colon tumor location with right worse than left-sided (HR, 1.21; 1.19-1.24; p < .001). Five-year overall survival for resection of the primary and metastatic site (28.2%) was higher than for no surgical treatment (4.7%). CONCLUSION Perioperative therapy was associated with improved survival, following resection of metastatic sites or primary tumor.
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Affiliation(s)
- Olatunji B Alese
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Katerina Zakka
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xingyue Huo
- Winship Research Informatics, Emory University, Atlanta, Georgia, USA
| | - Renjian Jiang
- Winship Research Informatics, Emory University, Atlanta, Georgia, USA
| | - Walid L Shaib
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mehmet Akce
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Madhusmita Behera
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.,Winship Research Informatics, Emory University, Atlanta, Georgia, USA
| | - Patrick Sullivan
- Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina Wu
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Bassel F El-Rayes
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Dixon M, Cruz J, Sarwani N, Gusani N. The Future Liver Remnant : Definition, Evaluation, and Management. Am Surg 2020; 87:276-286. [PMID: 32931301 DOI: 10.1177/0003134820951451] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
When considering patients for a major hepatectomy, one must carefully consider the volume of liver to be left behind and if additional procedures are necessary to augment its volume. This review considers the optimal volume of the future liver remnant (FLR) and analyzes the techniques of augmenting this volume, the various growth parameters to assess adequate growth of the FLR, as well as further management when there has been inadequate growth of the FLR.
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Affiliation(s)
- Matthew Dixon
- Division of Surgical Oncology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jeffrey Cruz
- Division of Surgical Oncology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.,Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.,Department of Medicine, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Nabeel Sarwani
- Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Niraj Gusani
- Division of Surgical Oncology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.,Department of Medicine, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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20
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Chun YJ, Kim SG, Lee KW, Cho SH, Kim TW, Baek JY, Park YS, Hong S, Chu CW, Beom SH, Jung M, Shin SJ, Ahn JB. A Randomized Phase II Study of Perioperative Chemotherapy Plus Bevacizumab Versus Postoperative Chemotherapy Plus Bevacizumab in Patients With Upfront Resectable Hepatic Colorectal Metastases. Clin Colorectal Cancer 2020; 19:e140-e150. [DOI: 10.1016/j.clcc.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/23/2020] [Accepted: 03/22/2020] [Indexed: 12/15/2022]
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21
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Ueno H, Konishi T, Ishikawa Y, Shimazaki H, Ueno M, Aosasa S, Saiura A, Shinto E, Kajiwara Y, Mochizuki S, Nakamura T, Yamamoto J. Primary Tumor Histology Affects Oncological Outcomes Independently of the Anatomical Extent of Disease in Colorectal Liver Metastasis. JMA J 2020; 3:240-250. [PMID: 33150258 PMCID: PMC7590386 DOI: 10.31662/jmaj.2018-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Growing evidence indicates the prognostic importance of the crosstalk between cancer cells and stroma through the induction of epithelial-mesenchymal transition (EMT). This study aimed to clarify the prognostic value of evaluating primary tumor histology with the anatomical extent of disease in patients with colorectal liver metastasis (CRLM). Methods Prognostic analyses were performed in 411 CRLM patients who underwent hepatectomy at two institutions. Tumors were graded into one of three histological categories based on integrated assessment of EMT-associated histology (HistologyEMT) in primary tumors, i.e., poorly differentiated clusters (PDCs) and desmoplastic reaction (DR). Results A prognostic grouping system for the anatomical extent of disease (N stage, liver metastasis number and size, and extrahepatic disease; Gradeanatomical) stratified patients into three groups with different five-year relapse-free survival (RFS) rates after hepatectomy: A, 31% (191 patients); B, 15% (124 patients); and C, 6% (96 patients; P < 0.0001). HistologyEMT (A, G1 PDC and mature-type DR; C, G3 PDC and immature-type DR; and B, others) identified 49, 120, and 242 patients with 46%, 5%, and 22% five-year RFS, respectively (P < 0.0001). Among prognostic factors, the Akaike information criterion was most favorable in Gradeanatomical, followed by HistologyEMT. Multivariate analysis demonstrated that these two factors independently impacted RFS; two-year RFS after hepatectomy in different patient groups had a wide range (10%-76%). Conclusions Histological assessment of dedifferentiation and the stromal environment of primary tumors contributed to effective risk stratification of early relapse after hepatectomy, which could be useful to determine clinical management for CRLM patients.
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Affiliation(s)
- Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Tsuyoshi Konishi
- Gastroenterology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Yuichi Ishikawa
- Division of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Hideyuki Shimazaki
- Department of Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Masashi Ueno
- Gastroenterology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Akio Saiura
- Gastroenterology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Satsuki Mochizuki
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Laboratory for Mathematics, National Defense Medical College, Tokorozawa, Japan.,Laboratory for Statistical Analysis, Center for Genomic Medicine, RIKEN, Tokyo, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, Saitama, Japan
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22
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Väyrynen V, Wirta EV, Seppälä T, Sihvo E, Mecklin JP, Vasala K, Kellokumpu I. Incidence and management of patients with colorectal cancer and synchronous and metachronous colorectal metastases: a population-based study. BJS Open 2020; 4:685-692. [PMID: 32543788 PMCID: PMC7397359 DOI: 10.1002/bjs5.50299] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background This population‐based study aimed to examine the incidence, patterns and results of multimodal management of metastatic colorectal cancer. Methods A retrospective population‐based study was conducted on patients with metastatic colorectal cancer in Central Finland in 2000–2015. Clinical and histopathological data were retrieved and descriptive analysis was conducted to determine the pattern of metastatic disease, defined as synchronous, early metachronous (within 12 months of diagnosis of primary disease) and late metachronous (more than 12 months after diagnosis). Subgroups were compared for resection and overall survival (OS) rates. Results Of 1671 patients, 296 (17·7 per cent) had synchronous metastases, and 255 (19·6 per cent) of 1302 patients with resected stage I–III tumours developed metachronous metastases (94 early and 161 late metastases). Liver, pulmonary and intraperitoneal metastases were the most common sites. The commonest metastatic patterns were a combination of liver and lung metastases. The overall metastasectomy rate for patients with synchronous metastases was 16·2 per cent; in this subgroup, 3‐ and 5‐year OS rates after any resection were 63 and 44 per cent respectively, compared with 7·1 and 3·3 per cent following no resection (P < 0·001). The resection rate was higher for late than for early metachronous disease (28·0 versus 17 per cent respectively; P = 0·048). Three‐ and 5‐year OS rates after any resection of metachronous metastases were 78 and 62 per cent respectively versus 42·1 and 18·2 per cent with no metastasectomy (P < 0·001). Similarly, 3‐ and 5‐year OS rates after any metastasectomy for early metachronous metastases were 57 and 50 per cent versus 84 and 66 per cent for late metachronous metastases (P = 0·293). Conclusion The proportion of patients with metastatic colorectal cancer was consistent with that in earlier population‐based studies, as were resection rates for liver and lung metastases and survival after resection. Differentiation between synchronous, early and late metachronous metastases can improve assessment of resectability and survival.
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Affiliation(s)
- V Väyrynen
- Departments of Gastrointestinal Surgery, Jyväskylä, Finland
| | - E-V Wirta
- Department of Gastrointestinal Surgery, Tampere University Hospital, Tampere, Finland
| | - T Seppälä
- Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland.,Department of Surgical Oncology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - E Sihvo
- Thoracic Surgery, Jyväskylä, Finland
| | - J-P Mecklin
- Departments of Gastrointestinal Surgery, Jyväskylä, Finland.,Faculty of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - K Vasala
- Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - I Kellokumpu
- Departments of Gastrointestinal Surgery, Jyväskylä, Finland
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23
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Ren L, Zhu D, Benson AB, Nordlinger B, Koehne CH, Delaney CP, Kerr D, Lenz HJ, Fan J, Wang J, Gu J, Li J, Shen L, Tsarkov P, Tejpar S, Zheng S, Zhang S, Gruenberger T, Qin X, Wang X, Zhang Z, Poston GJ, Xu J. Shanghai international consensus on diagnosis and comprehensive treatment of colorectal liver metastases (version 2019). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:955-966. [PMID: 32147426 DOI: 10.1016/j.ejso.2020.02.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022]
Abstract
The liver is the most common anatomical site for hematogenous metastases from colorectal cancer. Therefore effective treatment of liver metastases is one of the most challenging elements in the management of colorectal cancer. However, there is rare available clinical consensus or guideline only focusing on colorectal liver metastases. After six rounds of discussion by 195 clinical experts of the Shanghai International Consensus Expert Group on Colorectal Liver Metastases (SINCE) from 29 countries or regions, the Shanghai Consensus has been finally completed, based on current research and expert experience. The consensus emphasized the principle of multidisciplinary team, provided detailed diagnosis approaches, and guided precise local and systemic treatments. This Shanghai Consensus might be of great significance to standardized diagnosis and treatment of colorectal liver metastases all over the world.
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Affiliation(s)
- Li Ren
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dexiang Zhu
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Al B Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - Bernard Nordlinger
- Surgery Department, Hospital Ambroise-Pare, Boulogne-Billancourt, France
| | | | - Conor P Delaney
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Kerr
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai, China
| | - Jianping Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin Gu
- Department of Colorectal Surgery, Peking University Cancer Hospital, Beijing, China; Department of Colorectal Surgery, Peking University Shougang Hospital, Beijing, China
| | - Jin Li
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
| | - Petrv Tsarkov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sabine Tejpar
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Shu Zheng
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suzhan Zhang
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | | | - Xinyu Qin
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Graeme John Poston
- Surgery Department, Aintree University Hospital, School of Translational Studies, University of Liverpool, Liverpool, UK.
| | - Jianmin Xu
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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24
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Takagi Y, Sakai N, Yoshitomi H, Furukawa K, Takayashiki T, Kuboki S, Takano S, Suzuki D, Kagawa S, Mishima T, Nakadai E, Miyauchi H, Matsubara H, Ohtsuka M. High expression of Krüppel-like factor 5 is associated with poor prognosis in patients with colorectal cancer. Cancer Sci 2020; 111:2078-2092. [PMID: 32279400 PMCID: PMC7293098 DOI: 10.1111/cas.14411] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023] Open
Abstract
Krüppel‐like factor 5 (KLF5) plays an oncogenic role and has diverse functions in cancer cells. However, correlation between KLF5 and clinical outcome has not been determined in patients with colorectal cancer and colorectal liver metastasis. Herein, we analyzed 65 patients with colorectal cancer who developed colorectal liver metastasis. Clinical effects were assessed through immunohistochemical analysis of primary colorectal cancer lesions and metastatic liver lesions. High expression of KLF5 in these tissues correlated with the presence of vascular invasion, elevated serum carbohydrate antigen 19‐9 levels, large diameters of metastatic liver tumors, and poor prognosis following surgery. Multivariate analyses revealed that high expression of KLF5 was an independent prognostic factor. Increased expression of KLF5 in both colorectal cancer primaries and colorectal liver metastasis was significantly associated with shorter overall survival time and time to surgical failure. Krüppel‐like factor 5 expression positively correlated with Ki‐67 and c‐Myc expression in colorectal cancer tissues. In vitro experiments with colon cancer cell lines showed that siRNA knockdown of KLF5 inhibited cell proliferation. Western blot analyses revealed that knockdown of KLF5 expression reduced cyclin D1 and c‐Myc expression. It also impaired the stem cell‐like properties of cancer cells in tumorsphere formation assays. Furthermore, anoikis assay indicated that KLF5 contributed to anoikis resistance. High KLF5 expression is associated with poor prognosis in patients with colorectal cancer and liver metastasis by promoting cell proliferation and cancer stem cell‐like properties.
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Affiliation(s)
- Yutaka Takagi
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nozomu Sakai
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideyuki Yoshitomi
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Katsunori Furukawa
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsukasa Takayashiki
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuboki
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigetsugu Takano
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Suzuki
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Kagawa
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Mishima
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eri Nakadai
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideaki Miyauchi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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25
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Siebenhüner AR, Güller U, Warschkow R. Population-based SEER analysis of survival in colorectal cancer patients with or without resection of lung and liver metastases. BMC Cancer 2020; 20:246. [PMID: 32293337 PMCID: PMC7092492 DOI: 10.1186/s12885-020-6710-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Approximately one third of all patients with CRC present with, or subsequently develop, colorectal liver metastases (CRLM). The objective of this population-based analysis was to assess the impact of resection of liver only, lung only and liver and lung metastases on survival in patients with metastatic colorectal cancer (mCRC) and resected primary tumor. Methods Ten thousand three hundred twenty-five patients diagnosed with mCRC between 2010 and 2015 with resected primary were identified in the Surveillance, Epidemiology and End Results (SEER) database. Overall, (OS) and cancer-specific survival (CSS) were analyzed by Cox regression with multivariable, inverse propensity weight, near far matching and propensity score adjustment. Results The majority (79.4%) of patients had only liver metastases, 7.8% only lung metastases and 12.8% metastases of lung and liver. 3-year OS was 44.5 and 27.5% for patients with and without metastasectomy (HR = 0.62, 95% CI: 0.58–0.65, P < 0.001). Metastasectomy uniformly improved CSS in patients with liver metastases (HR = 0.72, 95% CI: 0.67–0.77, P < 0.001) but not in patients with lung metastases (HR = 0.84, 95% CI: 0.62–1.12, P = 0.232) and combined liver and lung metastases (HR = 0.89, 95% CI: 0.75–1.06, P = 0.196) in multivariable analysis. Adjustment by inverse propensity weight, near far matching and propensity score and analysis of OS yielded similar results. Conclusions This is the first SEER analysis assessing the impact of metastasectomy in mCRC patients with removed primary tumor on survival. The analysis provides compelling evidence of a statistically significant and clinically relevant increase in OS and CSS for liver resection but not for metastasectomy of lung or both sites.
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Affiliation(s)
- Alexander R Siebenhüner
- Clinic for Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, CH-8091, Zürich, Switzerland.
| | - Ulrich Güller
- University Clinic for Visceral Surgery and Medicine, University Hospital Berne, CH-3010, Berne, Switzerland.,Onkologie und Hämatologiezentrum Stial STS AG, CH-3600, Thun, Switzerland.,Division of Medical Oncology and Hematology, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland
| | - Rene Warschkow
- Department of Surgery, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland.,Institute of Medical Biometry and Informatics, University Heidelberg, 69120, Heidelberg, Germany
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26
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Sivesgaard K, Larsen LP, Sørensen M, Kramer S, Schlander S, Amanavicius N, Mortensen FV, Pedersen EM. Whole-body MRI added to gadoxetic acid-enhanced liver MRI for detection of extrahepatic disease in patients considered eligible for hepatic resection and/or local ablation of colorectal cancer liver metastases. Acta Radiol 2020; 61:156-167. [PMID: 31189329 DOI: 10.1177/0284185119855184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can detect extrahepatic disease before local treatment of colorectal liver metastases. Purpose To investigate if whole-body magnetic resonance imaging (MRI) added to gadoxetic acid liver MRI could replace FDG-PET/CT for detection of extrahepatic disease in patients with colorectal liver metastases eligible for hepatic local treatment. Material and Methods This health-research-ethics-committee-approved prospective consecutive diagnostic accuracy study with written informed consent analyzed 79 cases included between 29 June 2015 and 7 February 2017. Whole-body MRI covering the thorax, abdomen, and pelvis and FDG-PET/CT including contrast-enhanced CT was performed 0–3 days before local treatment of liver metastases. Whole-body MR images were read independently by two readers. FDG-PET/CT images were read independently by two pairs of readers. Histopathology and follow-up imaging were used as reference standard. Sensitivities and specificities were calculated and compared including noninferiority analysis. Results Seventy-five malignant lesions and 419 benign lesions were confirmed. Sensitivities of both PET/CT reader pairs 1 and 2 (56.7 and 67.9%) and MRI reader 2 (63.0%) were significantly higher than that of MRI reader 1 (42.7) (P<0.04). Specificities of both PET/CT reader pairs 1 and 2 (92.5 and 92.4%) and MRI reader 1 (91.1%) were significantly higher than that of MRI reader 2 (86.3%) ( P < 0.02). Sensitivity of MRI reader 2 was non-inferior compared to PET/CT reader pair 1. Specificities of both MRI readers were non-inferior to both PET/CT reader pairs. Conclusion For detection of extrahepatic disease in patients with colorectal liver metastases, whole-body MRI was non-inferior to FDG-PET/CT for some reader combinations. However, reader-independent non-inferiority could not be demonstrated.
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Affiliation(s)
- Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sørensen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Sven Schlander
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frank V Mortensen
- Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreato-biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Erik M Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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27
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Hasselgren K, Isaksson B, Ardnor B, Lindell G, Rizell M, Strömberg C, Loftås P, Björnsson B, Sandström P. Liver resection is beneficial for patients with colorectal liver metastases and extrahepatic disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:109. [PMID: 32175402 DOI: 10.21037/atm.2019.12.125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Liver metastases are the most common cause of death for patients with colorectal cancer and affect up to half of the patients. Liver resection is an established method that can potentially be curative. For patients with extrahepatic disease (EHD), the role of liver surgery is less established. Methods This is a retrospective study based on data from the national quality registry SweLiv. Data were obtained between 2009 and 2015. SweLiv is a validated registry and has been in use since 2009, with coverage above 95%. Patients with liver metastases and EHD were analyzed and cross-checked against the national death cause registry for survival analysis. Results During the study period, 2,174 patients underwent surgery for colorectal liver metastases (CRLM), and 277 patients with EHD were treated with resection or ablation. The estimated median survival time for the entire cohort from liver resection/ablation was 40 months (95% CI, 32-47). The survival time for patients treated with liver resection was 45 months compared to 26 months for patients treated with ablation (95% CI 38-53, 18-33, P=0.001). A subgroup analysis of resected patients revealed that the group with pulmonary metastases had a significantly longer estimated median survival (50 months; 95% CI, 39-60) than the group with lymph node metastases (32 months; 95% CI, 7-58) or peritoneal carcinomatosis (28 months; 95% CI, 14-41) (P=0.022 and 0.012, respectively). Other negative prognostic factors were major liver resection and nonradical liver resection. Conclusions For patients with liver metastases and limited EHD, liver resection results in prolonged survival compared to what can be expected from chemotherapy alone.
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Affiliation(s)
- Kristina Hasselgren
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bjarne Ardnor
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Gert Lindell
- Department of Surgery, Clinical Sciences, Lund University, Lund, Sweden
| | - Magnus Rizell
- Transplant Institute, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Strömberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Per Loftås
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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28
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Wang J, Li S, Liu Y, Zhang C, Li H, Lai B. Metastatic patterns and survival outcomes in patients with stage IV colon cancer: A population-based analysis. Cancer Med 2020; 9:361-373. [PMID: 31693304 PMCID: PMC6943094 DOI: 10.1002/cam4.2673] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/12/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The goal of this study was to delineate the patterns of distant metastasis from colon adenocarcinoma (CAC) and evaluate the survival differences by metastatic patterns. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted patients diagnosed with stage IV CAC between 2010 and 2016. Kaplan-Meier survival curves were plotted with log-rank tests to compare overall survival (OS) of patients with different metastatic patterns. Univariate and multivariate Cox proportional hazards regression models were used to evaluate the effects of different metastatic patterns on survival outcomes in terms of OS and disease-specific survival (DSS). RESULTS A total of 26 170 patients were analyzed. The 3- and 5-year OS were 20.7% and 10.5%, respectively, for patients with stage IV CAC. The most common distant metastatic site was the liver, followed by the lung, bone, and brain, but the frequency differed greatly by histology subtypes. The site of metastasis was a significant prognostic factor for OS and DSS in patients with stage IV CAC, independent of the number of metastatic sites and other clinical and demographic prognostic factors. Using liver-only metastasis as reference, lung-only metastasis was associated with better OS (hazard ratio [HR] = 0.82, 95% confidence interval [CI], 0.71-0.94) and DSS (HR = 0.75, 95% CI, 0.64-0.88). Older age, black race, unmarried status, grade III/IV tumors, advanced tumor-node-metastasis (TNM) stage, proximal colon, elevated preoperative carcinoembryonic antigen (CEA), no surgery of the primary site, and no chemotherapy were independent predictors of poor OS. CONCLUSIONS The site of distant metastasis and number of metastasis site were independent prognostic factors for survival of patients with stage IV CAC. This study highlights the need for diverse treatment strategies for patients with different metastatic patterns.
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Affiliation(s)
- Jiwei Wang
- Department of UltrasoundThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Song Li
- Mudanjiang Medical CollegeMudanjiangChina
| | - Yanna Liu
- Department of UltrasoundThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Chunquan Zhang
- Department of UltrasoundThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Honglang Li
- Department of Gastrointestinal SurgeryThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Bin Lai
- Department of Gastrointestinal SurgeryThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
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Benešová L, Hálková T, Ptáčková R, Semyakina A, Menclová K, Pudil J, Ryska M, Levý M, Šimša J, Pazdírek F, Hoch J, Blaha M, Minárik M. Significance of postoperative follow-up of patients with metastatic colorectal cancer using circulating tumor DNA. World J Gastroenterol 2019; 25:6939-6948. [PMID: 31908397 PMCID: PMC6938726 DOI: 10.3748/wjg.v25.i48.6939] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/05/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND One of the most notable applications for circulating tumor DNA (ctDNA) detection in peripheral blood of patients with metastatic colorectal cancer (mCRC) is a long-term postoperative follow-up. Sometimes referred to as a “liquid (re)biopsy” it is a minimally invasive procedure and can be performed repeatedly at relatively short intervals (months or even weeks). The presence of the disease and the actual extent of the tumor burden (tumor mass) within the patient’s body can be monitored. This is of particular importance, especially when evaluating radicality of surgical treatment as well as for early detection of disease progression or recurrence.
AIM To confirm the radicality of surgery using ctDNA and compare available methods for detection of recurrence in metastatic colorectal cancer.
METHODS A total of 47 patients with detected ctDNA and indications for resection of mCRC were enrolled in the multicenter study involving three surgical centers. Standard postoperative follow-ups using imaging techniques and the determination of tumor markers were supplemented by ctDNA sampling. In addition to the baseline ctDNA testing prior to surgery, a postoperative observation was conducted by evaluating ctDNA presence up to a week after surgery and subsequently at approximately three-month intervals. The presence of ctDNA was correlated with radicality of surgical treatment and the actual clinical status of the patient.
RESULTS Among the monitored patients, the R0 (curative) resection correlated with postoperative ctDNA negativity in 26 out of 28 cases of surgical procedures (26/28, 93%). In the remaining cases of R0 surgeries that displayed ctDNA, both patients were diagnosed with a recurrence of the disease after 6 months. In 7 patients who underwent an R1 resection, 4 ctDNA positivities (4/7, 57%) were detected after surgery and associated with the confirmation of early disease recurrence (after 3 to 7 months). All 15 patients (15/15, 100%) undergoing R2 resection remained constantly ctDNA positive during the entire follow-up period. In 22 cases of recurrence, ctDNA positivity was detected 22 times (22/22, 100%) compared to 16 positives (16/22, 73%) by imaging methods and 15 cases (15/22, 68%) of elevated tumor markers.
CONCLUSION ctDNA detection in patients with mCRC is a viable tool for early detection of disease recurrence as well as for confirmation of the radicality of surgical treatment.
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Affiliation(s)
- Lucie Benešová
- Centre for Applied Genomics of Solid Tumors, Genomac Research Institute, Prague CZ 161 00, Czech Republic
| | - Tereza Hálková
- Centre for Applied Genomics of Solid Tumors, Genomac Research Institute, Prague CZ 161 00, Czech Republic
| | - Renata Ptáčková
- Centre for Applied Genomics of Solid Tumors, Genomac Research Institute, Prague CZ 161 00, Czech Republic
| | - Anastasiya Semyakina
- Centre for Applied Genomics of Solid Tumors, Genomac Research Institute, Prague CZ 161 00, Czech Republic
| | - Kateřina Menclová
- Surgery Department, 2nd Faculty of Medicine of Charles University Prague and Military University Hospital, Prague CZ 169 02, Czech Republic
| | - Jiří Pudil
- Surgery Department, 2nd Faculty of Medicine of Charles University Prague and Military University Hospital, Prague CZ 169 02, Czech Republic
| | - Miroslav Ryska
- Surgery Department, 2nd Faculty of Medicine of Charles University Prague and Military University Hospital, Prague CZ 169 02, Czech Republic
| | - Miroslav Levý
- Surgery Department, 1st Faculty of Medicine, Charles University Prague and Thomayer Hospital, Prague CZ 140 59, Czech Republic
| | - Jaromír Šimša
- Surgery Department, 1st Faculty of Medicine, Charles University Prague and Thomayer Hospital, Prague CZ 140 59, Czech Republic
| | - Filip Pazdírek
- Surgery Department, 2nd Faculty of Medicine of Charles University Prague and Motol University Hospital, Prague CZ 150 06, Czech Republic
| | - Jiří Hoch
- Surgery Department, 2nd Faculty of Medicine of Charles University Prague and Motol University Hospital, Prague CZ 150 06, Czech Republic
| | - Milan Blaha
- Institute of Biostatistics and Analyses of the Masaryk University, Brno CZ 625 00, Czech Republic
| | - Marek Minárik
- Centre for Applied Genomics of Solid Tumors, Genomac Research Institute, Prague CZ 161 00, Czech Republic
- Elphogene, Prague CZ 161 00, Czech Republic
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Bae J, Hyer JM, Paredes AZ, Farooq A, Rice DR, White S, Tsilimigras DI, Ejaz A, Pawlik TM. Evaluation of costs and outcomes of physician-owned hospitals across common surgical procedures. Am J Surg 2019; 220:120-126. [PMID: 31619377 DOI: 10.1016/j.amjsurg.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The Affordable Care Act introduced restrictions on the creation of new physician-owned hospitals (POH). We sought to define whether POH status was associated with differences in care. METHODS Patients undergoing one of ten surgical procedures were identified using Medicare Standard Analytic Files. Patient and hospital-level characteristics and outcomes between POH and non-POH were compared. RESULTS Among 1,255,442 patients identified, 14,560 (1.2%) were treated at POH. A majority of POHs were in urban areas (n = 30, 90.9%) and none were in low socioeconomic status areas. Patients at POH were slightly younger (POH:72, IQR:68-77 vs. non-POH:73, IQR:69-79) and healthier (CCI; POH:2; IQR: 1-3 vs. non-POH: 3; IQR: 1-4). Patients at non-POH had higher odds of postoperative complications (OR:1.67, 95%CI:1.55-1.80) and slightly higher medical expenditures (POH:$11,347, IQR:$11,139-$11,936 vs. non-POH:$13,389, IQR:$11,381-$19,592). CONCLUSIONS POH were more likely to be located in socioeconomic advantaged areas, treat healthier patients and have lower associated expenditures.
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Affiliation(s)
- Junu Bae
- Ohio State University College of Medicine, Columbus, OH, USA; Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Ayesha Farooq
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Daniel R Rice
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Susan White
- Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Symonds LK, Cohen SA. Use of perioperative chemotherapy in colorectal cancer metastatic to the liver. Gastroenterol Rep (Oxf) 2019; 7:301-311. [PMID: 31687149 PMCID: PMC6821343 DOI: 10.1093/gastro/goz035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/06/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer. Aggressive treatments are most frequently administered to patients with isolated liver metastasis, though they may be judiciously considered for other sites of metastasis. To be considered for curative intent with surgery, patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant. Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability (so-called 'conversion' chemotherapy). While conversion chemotherapy in this setting aims to improve survival, the choice of a regimen remains a complex and highly individualized decision. In this review, we discuss the role of RAS status, primary site, sidedness, and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.
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Affiliation(s)
- Lynn K Symonds
- Division of Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stacey A Cohen
- Division of Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Hyde AJ, Nassabein R, AlShareef A, Armstrong D, Babak S, Berry S, Bossé D, Chen E, Colwell B, Essery C, Goel R, Goodwin R, Gray S, Hammad N, Jeyakuymar A, Jonker D, Karanicolas P, Lamond N, Letourneau R, Michael J, Patil N, Powell E, Ramjeesingh R, Saliba W, Singh R, Snow S, Stuckless T, Tadros S, Tehfé M, Thana M, Thirlwell M, Vickers M, Virik K, Welch S, Asmis T. Eastern Canadian Gastrointestinal Cancer Consensus Conference 2018. Curr Oncol 2019; 26:e665-e681. [PMID: 31708660 PMCID: PMC6821113 DOI: 10.3747/co.26.5193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference was held in Halifax, Nova Scotia, 20-22 September 2018. Experts in radiation oncology, medical oncology, surgical oncology, and pathology who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of pancreatic cancer, pancreatic neuroendocrine tumours, hepatocellular cancer, and rectal and colon cancer, including ■ surgical management of pancreatic adenocarcinoma,■ adjuvant and metastatic systemic therapy options in pancreatic adenocarcinoma,■ the role of radiotherapy in the management of pancreatic adenocarcinoma,■ systemic therapy in pancreatic neuroendocrine tumours,■ updates in systemic therapy for patients with advanced hepatocellular carcinoma,■ optimum duration of adjuvant systemic therapy for colorectal cancer, and■ sequence of therapy in oligometastatic colorectal cancer.
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Affiliation(s)
- A J Hyde
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - R Nassabein
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - A AlShareef
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - D Armstrong
- Newfoundland and Labrador-Dr. H. Bliss Murphy Cancer Centre, St. John's (Armstrong, Powell, Stuckless)
| | - S Babak
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - S Berry
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - D Bossé
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - E Chen
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - B Colwell
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - C Essery
- New Brunswick-Saint John Regional Hospital, Saint John (Gray, Michael)
| | - R Goel
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - R Goodwin
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - S Gray
- British Columbia-Penticton Regional Hospital, Penticton (Essery)
| | - N Hammad
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - A Jeyakuymar
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - D Jonker
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - P Karanicolas
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - N Lamond
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - R Letourneau
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - J Michael
- British Columbia-Penticton Regional Hospital, Penticton (Essery)
| | - N Patil
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - E Powell
- Newfoundland and Labrador-Dr. H. Bliss Murphy Cancer Centre, St. John's (Armstrong, Powell, Stuckless)
| | - R Ramjeesingh
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - W Saliba
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - R Singh
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - S Snow
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - T Stuckless
- Newfoundland and Labrador-Dr. H. Bliss Murphy Cancer Centre, St. John's (Armstrong, Powell, Stuckless)
| | - S Tadros
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - M Tehfé
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - M Thana
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - M Thirlwell
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - M Vickers
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - K Virik
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - S Welch
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - T Asmis
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
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Role of Repeat Resection in Patients With Metastatic Colorectal Cancer: A Multicenter Retrospective Study. Dis Colon Rectum 2019; 62:561-567. [PMID: 30614848 DOI: 10.1097/dcr.0000000000001311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little is known about repeat resection for recurrence exclusive of the liver and lungs and the natural history after the first curative resection in patients with metastatic colorectal cancer. OBJECTIVE This study aimed to investigate the role of repeat resection for recurrence of metastatic colorectal cancer in a Japanese cohort. DESIGN This is a multi-institution retrospective observational study. SETTING This study was conducted at participating tertiary referral hospitals. PATIENTS Patients with metastatic colorectal cancer who had synchronous distant metastases and underwent simultaneous resection of primary and distant disease or sequential staged resection at short intervals between 1997 and 2007 were included. MAIN OUTCOME MEASURES The primary outcomes measured were patterns of recurrence site, treatments, and survival. RESULTS A total of 1133 patients were identified, of whom 1073 were eligible. In total, 809 of the 1073 patients developed recurrence after curative resection, and 323 of these underwent repeat resection for recurrence. Of these, 211 developed re-recurrence; 80 of these patients underwent a second repeat resection. When stratified by site of recurrence, the 5-year overall survival rate in patients who underwent repeat resection was 56% in those with recurrence in the liver only, 43% in those with recurrence in the lung only, 30% in those with peritoneal seeding only, and 28% in those with multiple organ involvement. In patients who underwent a second repeat resection, the 5-year overall survival rates were 56%, 46%, 100%, and 50%. LIMITATIONS This study was limited by its retrospective study design. CONCLUSIONS Repeat surgery could have long-term survival benefit in patients with metastatic colorectal cancer who develop recurrence or re-recurrence in the liver or lung following curative resection. However, repeat surgery should be considered carefully in patients with peritoneal seeding only or recurrence at multiple sites. See Video Abstract at http://links.lww.com/DCR/A838.
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Nierop PMH, Galjart B, Höppener DJ, van der Stok EP, Coebergh van den Braak RRJ, Vermeulen PB, Grünhagen DJ, Verhoef C. Salvage treatment for recurrences after first resection of colorectal liver metastases: the impact of histopathological growth patterns. Clin Exp Metastasis 2019; 36:109-118. [PMID: 30843120 PMCID: PMC6445820 DOI: 10.1007/s10585-019-09960-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/04/2019] [Indexed: 12/23/2022]
Abstract
The majority of patients recur after resection of colorectal liver metastases (CRLM). Patients with CRLM displaying a desmoplastic histopathological growth pattern (dHGP) have a better prognosis and lower probability of recurrence than patients with non-dHGP CRLM. The current study evaluates the impact of HGP type on the pattern and treatment of recurrences after first resection of CRLM. A retrospective cohort study was performed, including patients with known HGP type after complete resection of CRLM. All patients were treated between 2000 and 2015. The HGP was determined on the CRLM resected at first partial hepatectomy. The prognostic value of HGPs, in terms of survival outcome, in the current patient cohort were previously published. In total 690 patients were included, of which 492 (71%) developed recurrent disease. CRLM displaying dHGP were observed in 103 patients (21%). Amongst patients with dHGP CRLM diagnosed with recurrent disease, more liver-limited recurrences were seen (43% vs. 31%, p = 0.030), whereas patients with non-dHGP more often recurred at multiple locations (34% vs. 19%, p = 0.005). Patients with dHGP CRLM were more likely to undergo curatively intended local treatment for recurrent disease (adjusted odds ratio: 2.37; 95% confidence interval (CI) [1.46-3.84]; p < 0.001) compared to patients with non-dHGP. The present study demonstrates that liver-limited disease recurrence after complete resection of CRLM is more often seen in patients with dHGP, whereas patients with non-dHGP more frequently experience multi-organ recurrence. Recurrences in patients with dHGP at first CRLM resection are more likely to be salvageable by local treatment modalities, but no prognostic impact of HGPs after salvage therapy for recurrent disease was found.
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Affiliation(s)
- Pieter M H Nierop
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Boris Galjart
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Diederik J Höppener
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric P van der Stok
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | - Peter B Vermeulen
- Translational Cancer Research Unit, (GZA Hospitals and University of Antwerp), Antwerp, Belgium
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Margonis GA, Buettner S, Andreatos N, Wagner D, Sasaki K, Galjart B, Kamphues C, Pawlik TM, Poultsides G, Kaczirek K, Lønning PE, Verhoef C, Kreis ME, Wolfgang CL, Weiss MJ. The prognosis of colorectal cancer liver metastases associated with inflammatory bowel disease: An exploratory analysis. J Surg Oncol 2018; 118:1074-1080. [PMID: 30261094 DOI: 10.1002/jso.25251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES In contrast with sporadic colorectal cancer liver metastases (CRLM), inflammatory bowel disease (IBD)-related CRLM have not been studied to date. METHODS Patients who underwent resection for IBD-related and sporadic CRLM from 2000 to 2015 were identified from an international registry and matched for pertinent prognostic variables. Overall survival (OS) and recurrence-free survival (RFS) were subsequently assessed. RESULTS Twenty-eight patients had IBD-related CRLM. Synchronous extrahepatic disease was more common in IBD-related CRLM patients than patients with sporadic CRLM (28.6% vs 8.3%; P < 0.001), most commonly located in the lungs. In multivariable analysis, IBD did not have a significant influence on OS ( P = 0.835), and had a hazard ratio (HR) close to 1 (HR, 0.95; 95% confidence interval [CI], 0.57-1.57). IBD was also not associated with inferior RFS (HR, 1.07; 95%CI, 0.68-1.68; P = 0.780). Among patients with IBD-related CRLM, 9(50%) had isolated intrahepatic recurrence and 8(44.4%) isolated extrahepatic recurrence, while only 1(5.6%) developed combined recurrence. Of those who experienced recurrence after resection of IBD-related CRLM, 10 had their recurrence treated with curative intent. CONCLUSIONS Patients with IBD-related CRLM had similar survival compared with patients with sporadic CRLM, even though they more often present with extrahepatic disease. In addition, patients with IBD-related CRLM may experience patterns of recurrence different from patients with sporadic CRLM.
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Affiliation(s)
- Georgios Antonios Margonis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany
| | - Stefan Buettner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nikolaos Andreatos
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Doris Wagner
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Kazunari Sasaki
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Boris Galjart
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Carsten Kamphues
- Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - George Poultsides
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Klaus Kaczirek
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Per Eystein Lønning
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Cornelis Verhoef
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Martin E Kreis
- Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany
| | | | - Matthew J Weiss
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Prasanna T, Karapetis CS, Roder D, Tie J, Padbury R, Price T, Wong R, Shapiro J, Nott L, Lee M, Chua YJ, Craft P, Piantadosi C, Sorich M, Gibbs P, Yip D. The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern. Acta Oncol 2018. [DOI: 10.1080/0284186x.2018.1487581 10.1080/0284186x.2018.1487581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
| | - Christos S. Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robert Padbury
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Timothy Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia
- Menzies Research Institute, Hobart, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - Yu Jo Chua
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | - Paul Craft
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | | | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
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Prasanna T, Karapetis CS, Roder D, Tie J, Padbury R, Price T, Wong R, Shapiro J, Nott L, Lee M, Chua YJ, Craft P, Piantadosi C, Sorich M, Gibbs P, Yip D. The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern. Acta Oncol 2018; 57:1438-1444. [PMID: 30035653 DOI: 10.1080/0284186x.2018.1487581] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 06/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pattern of spread in patients with metastatic colorectal cancer (mCRC) is variable and may reflect different biology in subsets of patients. This is a retrospective study to explore the outcome of patients with mCRC based on their site of metastasis at diagnosis and to explore the association between tumor characteristics [KRAS/RAS, BRAF, mismatch repair (MMR) status, site of primary] and the site of metastasis. METHODS Patients from two Australian databases were divided into six groups based on site of metastasis at time of diagnosis of metastatic disease; lung-only, liver-only, lymph node-only or any patients with brain, bone or peritoneal metastases. Primary endpoint was overall survival (OS) of each cohort compared with the rest of the population. A Mantel-Haenszel chi-squared test used to explore the association between site of metastasis and selected tumor characteristics. RESULTS Five thousand nine hundred and sixty-seven patients were included. In a univariate analysis, median OS was significantly higher when metastases were limited to lung or liver and shorter for those with brain, bone or peritoneal metastases (p < .001) in both datasets. BRAF mutation was strongly associated with peritoneal metastases (relative risk = 1.8, p < .001) with lower incidence of lung (RR = 0.3, p = .004) and liver (RR = 0.7, p = .005) limited metastases. Lung-only metastases were more frequent with KRAS/RAS mutation (RR = 1.4, p = .007). Left colon tumors were associated with bone (RR = 1.6, p < .001) and lung-only metastases (RR = 2.3, p = .001) while peritoneal spread was less frequent compared with right colon tumors (RR = 0.6, p < .001). Rectal cancer was associated with brain, bone and lung metastases (RR = 1.7; p = .002, 1.7; p < .001, 2.0; p < .001). Liver-only metastases were less frequent in deficient MMR tumors (RR = 0.7, p = .01). CONCLUSION Survival duration with mCRC is related to the site of metastases with lung limited disease showing a more favorable survival outcome compared to other single metastatic site disease. The BRAF mutation and primary rectal cancer were associated with poor prognostic metastatic sites.
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Affiliation(s)
- Thiru Prasanna
- a Department of Medical Oncology , The Canberra Hospital , Garran , Canberra , Australia
| | - Christos S Karapetis
- b Department of Medical Oncology , Flinders Medical Centre , Bedford Park , Australia
- c Flinders Clinical and Molecular Medicine, Surgery, Flinders University , Bedford Park , Australia
| | - David Roder
- d South Australian Health & Medical Research Institute (SAHMRI) , Adelaide, Australia
- e School of Health Sciences, University of South Australia , Adelaide , Australia
| | - Jeanne Tie
- f Department of Medical Oncology , Western Hospital , Melbourne , Australia
- g Walter and Eliza Hall Institute of Medical Research , Melbourne , Australia
- h Department of Medical Oncology , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Robert Padbury
- c Flinders Clinical and Molecular Medicine, Surgery, Flinders University , Bedford Park , Australia
- i Department of Surgery , Flinders Medical Centre , Adelaide, Australia
| | - Timothy Price
- j The Queen Elizabeth Hospital and University of Adelaide , Adelaide , Australia
| | - Rachel Wong
- g Walter and Eliza Hall Institute of Medical Research , Melbourne , Australia
- k Department of Medical Oncology , Eastern Health , Melbourne , Australia
- l Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne , Australia
| | - Jeremy Shapiro
- m Cabrini Haematology and Oncology Centre , Melbourne , Australia
| | - Louise Nott
- n Department of Medical Oncology , Royal Hobart Hospital , Tasmania , Australia
- o Menzies Research Institute , Hobart , Australia
| | - Margaret Lee
- g Walter and Eliza Hall Institute of Medical Research , Melbourne , Australia
- k Department of Medical Oncology , Eastern Health , Melbourne , Australia
| | - Yu Jo Chua
- a Department of Medical Oncology , The Canberra Hospital , Garran , Canberra , Australia
- p ANU Medical School, Australian National University , Canberra , Australia
| | - Paul Craft
- a Department of Medical Oncology , The Canberra Hospital , Garran , Canberra , Australia
- p ANU Medical School, Australian National University , Canberra , Australia
| | | | - Michael Sorich
- r College of Medicine and Public Health , Flinders University , Adelaide , Australia
| | - Peter Gibbs
- f Department of Medical Oncology , Western Hospital , Melbourne , Australia
- g Walter and Eliza Hall Institute of Medical Research , Melbourne , Australia
| | - Desmond Yip
- a Department of Medical Oncology , The Canberra Hospital , Garran , Canberra , Australia
- p ANU Medical School, Australian National University , Canberra , Australia
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Gootjes EC, Bakkerus L, Ten Tije AJ, Witteveen PO, Buffart TE, Bridgewater JA, Primrose JN, Verhoef C, Verheul HMW. The value of tumour debulking for patients with extensive multi-organ metastatic colorectal cancer. Eur J Cancer 2018; 103:160-164. [PMID: 30243064 DOI: 10.1016/j.ejca.2018.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 07/08/2018] [Indexed: 02/07/2023]
Abstract
Local treatment of metastases by surgical resection or other ablative therapies is technically feasible in an increasing number of patients with multi-organ metastatic cancer. This results in a growing debate on whether patients with extensive disease, that is traditionally deemed unresectable, may benefit from local treatment of metastases when added to standard palliative systemic therapy. For selected patients with oligometastatic colorectal cancer, local treatment of metastases has become the standard of care based on retrospective reports showing long-term survival rates. In addition to systemic therapy, preliminary evidence suggests that patients with extensive metastatic colorectal cancer may also benefit from local treatment. Here, we present the future perspectives based on the available literature on local treatment approaches in colorectal cancer.
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Affiliation(s)
- Elske C Gootjes
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Lotte Bakkerus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Albert J Ten Tije
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands; Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | | | - Tineke E Buffart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | | | - John N Primrose
- University Surgery and Cancer Sciences Division, University of Southampton, Southampton General Hospital, Southampton UK
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Henk M W Verheul
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
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Luo D, Liu Q, Yu W, Ma Y, Zhu J, Lian P, Cai S, Li Q, Li X. Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study. Int J Colorectal Dis 2018; 33:1241-1249. [PMID: 29931408 DOI: 10.1007/s00384-018-3091-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE We investigated the prognostic value of distant metastasis sites among patients with metastatic colorectal cancer (CRC) and the significance of metastasectomy and resection of the primary CRC. METHODS Between 2010 and 2014, patients diagnosed with metastatic colorectal adenocarcinoma were selected using the surveillance, epidemiology, and end results (SEER) database. The prognosis of these patients was compared according to the site of metastasis (liver, lung, bone, and brain). A total of 15,133 patients suffered from isolated organ involvement, while 5135 patients experienced multiple organ metastases. RESULTS In the isolated organ metastasis cohort, median overall survival (OS) for patients with liver, lung, bone, and brain metastases was 16, 20, 7, and 5 months, respectively. Patients with isolated lung metastases had better cancer-specific survival (CSS) and OS as compared to patients with metastases at any other sites (p < 0.0001 for both CSS and OS). Patients with isolated liver metastases had better prognosis as compared to patients with isolated bone or brain metastases (p < 0.0001 for both CSS and OS). Moreover, patients with a single metastatic site had better prognosis than patients with multiple organs involved (p < 0.0001 for both CSS and OS). Multivariate analysis in patients with isolated organ metastases demonstrated that age ≤ 60 years, rectal cancer, being married, non-black race, N0 stage, and surgery of the primary and distant lesions showed more favorable prognosis. CONCLUSIONS The metastatic site was an independent prognostic factor in stage IV colorectal cancer. Also, carefully chosen patients may benefit from surgery.
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Affiliation(s)
- Dakui Luo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wencheng Yu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yanlei Ma
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ji Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Peng Lian
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Donadon M, Lleo A, Di Tommaso L, Soldani C, Franceschini B, Roncalli M, Torzilli G. The Shifting Paradigm of Prognostic Factors of Colorectal Liver Metastases: From Tumor-Centered to Host Immune-Centered Factors. Front Oncol 2018; 8:181. [PMID: 29892573 PMCID: PMC5985314 DOI: 10.3389/fonc.2018.00181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
The determinants of prognosis in patients with colorectal liver metastases (CLM) have been traditionally searched among the tumoral factors, either of the primary colorectal tumor or of the CLM. While many different scoring systems have been developed based on those clinic-pathological factors with disparate results, there has been the introduction of genetic biological markers that added a theranostic perspective. More recently, other important elements, such as those factors related to the host immune system, have been proposed as determinants of prognosis of CLM patients. In the present work, we review the current prognostic factors of CLM patients as well as the burgeoning shifting paradigm of prognostication that relies on the host immune system.
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Affiliation(s)
- Matteo Donadon
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
- Department of Biomedical Science, Humanitas University, Rozzano, Italy
| | - Ana Lleo
- Department of Biomedical Science, Humanitas University, Rozzano, Italy
- Department of Internal Medicine, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Luca Di Tommaso
- Department of Biomedical Science, Humanitas University, Rozzano, Italy
- Department of Pathology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Cristiana Soldani
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Barbara Franceschini
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Massimo Roncalli
- Department of Biomedical Science, Humanitas University, Rozzano, Italy
- Department of Pathology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Guido Torzilli
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
- Department of Biomedical Science, Humanitas University, Rozzano, Italy
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Acciuffi S, Meyer F, Bauschke A, Settmacher U, Lippert H, Croner R, Altendorf-Hofmann A. Analysis of prognostic factors after resection of solitary liver metastasis in colorectal cancer: a 22-year bicentre study. J Cancer Res Clin Oncol 2018; 144:593-599. [PMID: 29340767 DOI: 10.1007/s00432-018-2583-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/11/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE The investigation of the predictors of outcome after hepatic resection for solitary colorectal liver metastasis. METHODS We recruited 350 patients with solitary colorectal liver metastasis at the University Hospitals of Jena and Magdeburg, who underwent curative liver resection between 1993 and 2014. All patients had follow-up until death or till summer 2016. RESULTS The follow-up data concern 96.6% of observed patients. The 5- and 10-year overall survival rates were 47 and 28%, respectively. The 5- and 10-year disease-free survival rates were 30 and 20%, respectively. The analysis of the prognostic factors revealed that the pT category of primary tumour, size and grade of the metastasis and extension of the liver resection had no statistically significant impact on survival and recurrence rates. In multivariate analysis, age, status of lymph node metastasis at the primary tumour, location of primary tumour, time of appearance of the metastasis, the use of preoperative chemotherapy and the presence of extrahepatic tumour proved to be independent statistically significant predictors for the prognosis. Moreover, patients with rectal cancer had a lower intrahepatic recurrence rate, but a higher extrahepatic recurrence rate. CONCLUSION The long-term follow-up of patients with R0-resected liver metastasis is multifactorially influenced. Age and comorbidity have a role only in the overall survival. More than three lymph node metastasis reduced both the overall and disease-free survival. Extrahepatic tumour had a negative influence on the extrahepatic recurrence and on the overall survival. Neither overall survival nor recurrence rates was improved using neoadjuvant chemotherapy.
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Affiliation(s)
- Sara Acciuffi
- Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
| | - Frank Meyer
- Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
| | - Astrid Bauschke
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Utz Settmacher
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Hans Lippert
- Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
| | - Roland Croner
- Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
| | - Annelore Altendorf-Hofmann
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Lam M, Loree JM, Pereira AAL, Chun YS, Kopetz S. Accelerating Therapeutic Development through Innovative Trial Design in Colorectal Cancer. Curr Treat Options Oncol 2018; 19:11. [PMID: 29488033 DOI: 10.1007/s11864-018-0524-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Current trial design is challenged by the advancement of technologies that have enabled deeper understanding of the molecular drivers of colorectal cancer (CRC). The speed of trial testing and the ability to test larger volumes of promising novel agents in the face of smaller populations identified by molecular profiling are challenges posed to clinical studies. Master protocols that utilize umbrella designs are equipped to deal with potential biomarker and matched treatments simultaneously. Although complex in nature, they increase trial efficiency by utilizing shared screening platforms, test multiple treatments together, and simplify regulatory submission and reporting under a common protocol. Emerging technologies such as circulating tumor DNA (ctDNA) may help speed up adjuvant trials. These studies have been traditionally slow to complete due to low event rates and the high numbers needed to recruit. ctDNA used as a surrogate for minimal residual disease (MRD) and as an early marker of relapse may help counter some of these factors that deter innovation in this setting. Finally, in the era of precision medicine, surgery should not be forgotten as the only potentially curative option to date in metastatic disease. Five-year overall survival following resection of liver metastasis exceeds what can be achieved with chemotherapy alone in selected cases. Surgical advances have lowered morbidity and allow for greater resection volumes and repeated interventions. Although historically challenging, a well-designed randomized surgical intervention trial would greatly facilitate moving single-institution guidelines reported by case series into wider clinical practice.
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Affiliation(s)
- Michael Lam
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 0426, Houston, TX, 77030, USA
| | - Jonathan M Loree
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 0426, Houston, TX, 77030, USA
| | - Allan Anderson Lima Pereira
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 0426, Houston, TX, 77030, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 0426, Houston, TX, 77030, USA.
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Swaid F, Tsung A. Current Management of Liver Metastasis From Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0397-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Haraldsdottir S, Goldberg RM. Conversion Therapy for Initially Borderline/Unresectable Metastases in Colon Cancer: What Is the Best Neoadjuvant Chemotherapy? CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0393-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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45
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Maher B, Ryan E, Little M, Boardman P, Stedman B. The management of colorectal liver metastases. Clin Radiol 2017; 72:617-625. [DOI: 10.1016/j.crad.2017.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023]
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46
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Ejaz A, Reames BN, Maithel S, Poultsides GA, Bauer TW, Fields RC, Weiss M, Marques HP, Aldrighetti L, Pawlik TM. The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis. J Surg Oncol 2017. [PMID: 28650564 DOI: 10.1002/jso.24727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Management of neuroendocrine liver metastasis (NELM) in the presence of extrahepatic disease (EHD) is controversial. We sought to examine outcomes of patients undergoing liver-directed therapy (resection, ablation, or both) for NELM in the presence of EHD using a large international cohort of patients. METHODS 612 patients who underwent liver-directed therapy were identified from eight institutions. Postoperative outcomes, as well as and overall (OS) were compared among patients with and without EHD. RESULTS Most primary tumors were located in the pancreas (N = 254;41.8%) or the small bowel (N = 188;30.9%). Patients underwent surgery alone (N = 471;77.0%), ablation alone (N = 15;2.5%), or a combined approach (N = 126;20.6%). Patients with EHD had more high-grade tumors (EHD: 44.4% vs no EHD: 16.1%; P < 0.001). EHD was often the peritoneum (N = 29;41.4%) or lung (N = 19;27.1%). Among 70 patients with EHD, 20.0% (N = 14) underwent concurrent resection for EHD. After median follow-up of 51 months, 174 (28.4%) patients died with a median OS of 140.4 months. Patients with EHD had a shorter median OS versus patients who did not have EHD (EHD: 87 months vs no EHD: not reached; P = 0.002). EHD was independently associated with an increased risk of death (HR: 2.56, 95%CI 1.16-5.62; P = 0.02). CONCLUSION Patients with NELM and EHD had more aggressive tumors, conferring a twofold increased risk of death. Surgical treatment of NELM among patients with EHD should be individualized.
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Affiliation(s)
- Aslam Ejaz
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Brad N Reames
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - George A Poultsides
- Department of Surgery, School of Medicine, Stanford University, Stanford, California
| | - Todd W Bauer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Ryan C Fields
- Department of Surgery, School of Medicine, Washington University, St Louis, Missouri
| | - Matt Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Luca Aldrighetti
- Department of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Abstract
OBJECTIVE The aim of the study was to evaluate outcomes after resection of colorectal liver metastases (CRLM) and concurrent extrahepatic disease (EHD), and to define prognostic factors. BACKGROUND There is increasing evidence to support resection of liver metastases and concurrent EHD in selected patients. Long-term survival data are lacking, and prognostic factors are not well defined. METHODS Retrospective review of 219 patients was undertaken between January 1992 and December 2012, who underwent hepatectomy for CRLM and resection of synchronous EHD. Survival outcomes were estimated by the Kaplan-Meier method. Univariate and multivariate analyses of prognostic factors were performed. A scoring system for prognostication was developed. RESULTS The median, 3, 5, and 10-year overall survival were 34.4 months, 49%, 28%, and 10%, respectively. Disease recurred in 185 patients (90.2%) at a median of 8 months. There were 8 actual 10-year survivors. The site of EHD affected survival, with portal, retroperitoneal nodes and multiple sites associated with the worst prognoses. The size of the largest CRLM, the number of CRLM, unfavorable site of EHD, and progression of CRLM on neoadjuvant therapy were associated with overall survival on univariate and multivariate analyses. Three variables, assigned 1 point each, were used to create an EHD risk score: largest CRLM greater than 3 cm, greater than 5 CRLM, and unfavorable site of EHD. The resulting score was prognostic of overall and recurrence-free survival. CONCLUSIONS Long-term survival is possible after resection of liver metastases and concurrent EHD, but true cure is rare. A proposed scoring system may identify patients most likely to benefit from surgery.
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48
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Al Bandar MH, Kim NK. Current status and future perspectives on treatment of liver metastasis in colorectal cancer (Review). Oncol Rep 2017; 37:2553-2564. [PMID: 28350137 DOI: 10.3892/or.2017.5531] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/13/2017] [Indexed: 12/29/2022] Open
Abstract
Liver metastasis is the most common site of colorectal cancer (CRC) metastasis. Approximately half of all colorectal cancer patients will develop liver metastases. Although radical surgery is the standard treatment modality, only 10-20% of patients are deemed eligible for resection. Despite advances in survival with chemotherapy, surgical resection is still considered the only curative option for patients with liver metastases. Much effort has been expended to address patients with metastatic liver disease. The majority of evidence stated a significant survival benefit with surgical resection to reach an overall 5-year survival rate of 35-55% after hepatic resection. However, still majority of patients will experience disease recurrence even after a successful resection. In this review, we describe current status and controversies related to treatment options for CRC liver metastases and its potential for enhancing oncologic outcomes and improving quality of life.
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Affiliation(s)
- Mahdi Hussain Al Bandar
- Department of Surgery, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University, College of Medicine, Seoul 120-752, Republic of Korea
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49
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Torres OJM, Marques MC, Santos FN, Farias ICD, Coutinho AK, Oliveira CVCD, Kalil AN, Mello CALD, Kruger JAP, Fernandes GDS, Quireze C, Murad AM, Silva MJDBE, Zurstrassen CE, Freitas HC, Cruz MR, Weschenfelder R, Linhares MM, Castro LDS, Vollmer C, Dixon E, Ribeiro HSDC, Coimbra FJF. BRAZILIAN CONSENSUS FOR MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 3: CONTROVERSIES AND UNRESECTABLE METASTASES. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:173-179. [PMID: 27759781 PMCID: PMC5074669 DOI: 10.1590/0102-6720201600030011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/26/2016] [Indexed: 12/14/2022]
Abstract
In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization.
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Affiliation(s)
- Orlando Jorge Martins Torres
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Brazilian Society of Clinical Oncology (BSCO)
| | - Márcio Carmona Marques
- Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Fabio Nasser Santos
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA)
| | - Igor Correia de Farias
- Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Cássio Virgílio Cavalcante de Oliveira
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS)
| | - Antonio Nocchi Kalil
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Brazilian College of Digestive Surgery (BCDS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Jaime Arthur Pirola Kruger
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Claudemiro Quireze
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | | | | | | | | | | | - Marcelo Moura Linhares
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian College of Digestive Surgery (BCDS).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Leonaldson Dos Santos Castro
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | | | - Elijah Dixon
- Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Héber Salvador de Castro Ribeiro
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Americas Hepato-Pancreato-Biliary Association - AHPBA
| | - Felipe José Fernandez Coimbra
- Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA).,Brazilian Society of Surgical Oncology (BSSO).,Brazilian College of Surgeons (BCS).,Americas Hepato-Pancreato-Biliary Association - AHPBA
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50
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Ferguson CD, Luis CR, Steinke K. Safety and efficacy of microwave ablation for medically inoperable colorectal pulmonary metastases: Single-centre experience. J Med Imaging Radiat Oncol 2017; 61:243-249. [DOI: 10.1111/1754-9485.12600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/23/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Craig D Ferguson
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Chris R Luis
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Karin Steinke
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
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