51
|
Zhang L, Song R, Gu D, Zhang X, Yu B, Liu B, Xie J. The role of GLI1 for 5-Fu resistance in colorectal cancer. Cell Biosci 2017; 7:17. [PMID: 28413604 PMCID: PMC5390459 DOI: 10.1186/s13578-017-0145-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/08/2017] [Indexed: 12/31/2022] Open
Abstract
Colorectal cancer is a leading cause of cancer-related mortality worldwide, with Fluorouracil (5-FU)-based chemotherapy as the major treatment for advanced disease. Many patients with advanced colorectal cancer eventually succumb to the disease despite some patients responded initially to chemotherapy. Thus, identifying molecular mechanisms responsible for chemotherapy resistance will help design novel strategies to treat colorectal cancer. In this study, we established an acquired 5-FU resistant cell line, LoVo-R, from LoVo cells. Through exome sequencing, we discovered that elevated GLI1 signaling axis is a major genetic alteration in the 5-FU resistant cells. Hh signaling, a pathway essential for embryonic development, is an important regulator for residual cancer cells. We demonstrated that knockdown of GLI1 or GLI2 sensitized LoVo-R cells to 5-FU treatment, reduced cell invasiveness. The relevance of our studies to colorectal cancer patients is reflected by our discovery that high expression of GLI1 signaling molecules was associated with a high incidence of cancer relapse and a shorter survival in a larger cohort of colorectal cancer patients who underwent chemotherapy (containing 5-FU). Taken together, our data demonstrate the critical role of the GLI1 signaling axis for 5-FU resistance in colorectal cancer.
Collapse
Affiliation(s)
- Lining Zhang
- Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Ruolan Song
- Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China.,Departments of Pediatrics, Biochemistry and Molecular Biology, Pharmacology and Toxicology, The Wells Center for Pediatrics Research and IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Dongsheng Gu
- Departments of Pediatrics, Biochemistry and Molecular Biology, Pharmacology and Toxicology, The Wells Center for Pediatrics Research and IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Xiaoli Zhang
- Departments of Pediatrics, Biochemistry and Molecular Biology, Pharmacology and Toxicology, The Wells Center for Pediatrics Research and IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Beiqin Yu
- Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Bingya Liu
- Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jingwu Xie
- Departments of Pediatrics, Biochemistry and Molecular Biology, Pharmacology and Toxicology, The Wells Center for Pediatrics Research and IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| |
Collapse
|
52
|
Suárez J, Marín G, Vera R, Colibaseanu D, Vila JJ, Ciga MA, Oronoz B. Stent placement prior to initiation of chemotherapy in patients with obstructive, nonoperative left sided tumors is associated with fewer stomas. J Surg Oncol 2017; 115:856-863. [DOI: 10.1002/jso.24588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/07/2017] [Accepted: 02/02/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Javier Suárez
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| | - Gabriel Marín
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| | - Ruth Vera
- Department of Medical Oncology; Complejo Hospitalario de Navarra; Pamplona Spain
| | - Dorin Colibaseanu
- Department of Surgery; Section of Colon and Rectal Surgery, Mayo Clinic; Jacksonville Florida
| | - Juan J. Vila
- Department of Gastroenterology; Complejo Hospitalario de Navarra; Pamplona Spain
| | - Miguel A. Ciga
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| | - Begoña Oronoz
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| |
Collapse
|
53
|
You YN, Eng C, Aloia T. Multidisciplinary management of stage IV colon cancer. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.020] [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]
|
54
|
Lee B, Wong HL, Tacey M, Tie J, Wong R, Lee M, Nott L, Shapiro J, Jennens R, Turner N, Tran B, Ananda S, Yip D, Richardson G, Parente P, Lim L, Stefanou G, Burge M, Iddawela M, Power J, Gibbs P. The impact of bevacizumab in metastatic colorectal cancer with an intact primary tumor: Results from a large prospective cohort study. Asia Pac J Clin Oncol 2016; 13:314-321. [PMID: 27885818 DOI: 10.1111/ajco.12639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Debate continues regarding the benefits versus risks of initial resection of the primary tumor in metastatic colorectal cancer (mCRC) patients with an asymptomatic primary tumor. Although the benefit of the anti-vascular endothelial growth factor agent bevacizumab alongside first-line chemotherapy in mCRC is established, the impact of bevacizumab on the intact primary tumor (IPT) is less well understood. METHODS Data from an Australian mCRC registry were used to assess the impact of bevacizumab-based regimens in the presence of an IPT, to see if this differs from effects in resected primary tumor (RPT) patients and to understand the safety profile of bevacizumab in patients with IPT. Progression-free survival (PFS), overall survival (OS) and safety endpoints were analyzed. RESULTS Of 1204 mCRC patients, 826 (69%) were eligible for inclusion. Bevacizumab use was similar in both arms (IPT (64%) versus RPT (70%)); compared with chemotherapy alone, bevacizumab use was associated with significantly longer PFS (IPT: 8.5 months vs 4.7 months, P = 0.017; RPT: 10.8 months vs 5.8 months, P < 0.001) and OS (IPT: 20 months vs 14.8 months, P = 0.005; RPT: 24.4 months vs 17.3 months, P = 0.004)).1 Bevacizumab use in an IPT was associated with more GI perforations (4.5% vs 1.8%, P = 0.210) but less frequent bleeding (1.5% vs 5.3%, P = 0.050) and thrombosis (1.5% vs 2.7%, P = 0.470), versus chemotherapy alone. Median survival was equivalent between patients that did or did not experience bevacizumab-related adverse events - 20.0 months versus 19.9 months, hazard ratio = 0.98, P = 0.623.1 CONCLUSIONS: The addition of bevacizumab significantly improved survival outcomes in mCRC with an IPT. The occurrence of bevacizumab-related adverse events did not significantly impact survival outcomes.
Collapse
Affiliation(s)
- Belinda Lee
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry & Health Sciences University of Melbourne, Melbourne, VIC, Australia
| | - Hui-Li Wong
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry & Health Sciences University of Melbourne, Melbourne, VIC, Australia
| | - Mark Tacey
- Faculty of Medicine, Dentistry & Health Sciences University of Melbourne, Melbourne, VIC, Australia.,Melbourne EpiCenter, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
| | - Jeanne Tie
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.,Western Health, Department of Medical Oncology, Boxhill, TAS, Australia
| | - Rachel Wong
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Eastern Health, Department of Medical Oncology, Boxhill, TAS, Australia.,Monash University, Department of Medicine, Nursing and Health Sciences, Hobart, TAS, Australia
| | - Margaret Lee
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.,Eastern Health, Department of Medical Oncology, Boxhill, TAS, Australia
| | - Louise Nott
- Royal Hobart Hospital, Department of Medical Oncology, Hobart, TAS, Australia
| | - Jeremy Shapiro
- Monash University, Department of Medicine, Nursing and Health Sciences, Hobart, TAS, Australia.,Cabrini Health, Department of Medical Oncology, Malvern, VIC, Australia
| | - Ross Jennens
- Epworth Hospital, Department of Medical Oncology, Richmond, VIC, Australia
| | - Natalie Turner
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
| | - Ben Tran
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
| | - Sumitra Ananda
- Western Health, Department of Medical Oncology, Boxhill, TAS, Australia
| | - Desmond Yip
- Canberra and Calvary Hospitals, Department of Medical Oncology, Garran, ACT, Australia
| | - Gary Richardson
- Cabrini Health, Department of Medical Oncology, Malvern, VIC, Australia
| | - Phillip Parente
- Eastern Health, Department of Medical Oncology, Boxhill, TAS, Australia.,Monash University, Department of Medicine, Nursing and Health Sciences, Hobart, TAS, Australia
| | - Lionel Lim
- Eastern Health, Department of Medical Oncology, Boxhill, TAS, Australia
| | - Greg Stefanou
- John Fawkner Hospital, Department of Medical Oncology, Coburg, VIC, Australia
| | - Matthew Burge
- Royal Brisbane Hospital, Department of Medical Oncology, Brisbane, QLD, Australia
| | - Mahesh Iddawela
- Goulburn Valley Health, Department of Medical Oncology, Shepparton, VIC, Australia
| | - Jeremy Power
- Launceston General Hospital, Department of Medical Oncology, Launceston, TAS, Australia
| | - Peter Gibbs
- Systems Biology & Personalized Medicine Division, Walter & Eliza Hall Institute (WEHI), Melbourne, VIC, Australia.,Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry & Health Sciences University of Melbourne, Melbourne, VIC, Australia.,Western Health, Department of Medical Oncology, Boxhill, TAS, Australia
| |
Collapse
|
55
|
Healy MA, Pradarelli JC, Krell RW, Regenbogen SE, Suwanabol PA. Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers. Dis Colon Rectum 2016; 59:1047-1054. [PMID: 27749480 PMCID: PMC5119894 DOI: 10.1097/dcr.0000000000000684] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite substantially improved survival with metastatic site resection in colorectal cancers, uptake of aggressive surgical approaches remains low among certain patients. It is unknown whether financial determinants of care, such as insurance status, play a role in this treatment gap. OBJECTIVE We sought to evaluate the effect of insurance status on metastasectomy in patients with advanced colorectal cancers. DESIGN This was a retrospective cohort study. SETTINGS Using the National Cancer Data Base Participant User File, incident cases of colorectal cancer metastatic to the lung and/or liver with diagnosis from 2010 to 2013 were identified. PATIENTS We identified 42,300 patients in our cohort with a mean age 64 years. MAIN OUTCOME MEASURES Controlling for patient, tumor, and hospital characteristics, hierarchical regression was used to examine associations between hospital payer mix and metastatic site resection. Metastatic site resection occurred in 12.3% of all patients. RESULTS Adjusting for patient and hospital fixed effects, we found that patients who were uninsured or on Medicaid were 38% less likely to undergo metastasectomy (OR = 0.62 (95% CI, 0.56-0.66)). Patients in hospitals with staff treating a high percentage of uninsured patients or patients with Medicaid were less likely to undergo metastasectomy, even after controlling for individual patient insurance status. LIMITATIONS The study was limited by its retrospective design and the granularity and accuracy of the National Cancer Data Base. CONCLUSIONS Differences in insurance status and hospital payer mix are associated with differences in rates of metastatic site resection in patients with colorectal cancer that is metastatic to the lung and/or liver. There is a need for improved access to metastatic site resection for individual patients who are uninsured or who have Medicaid insurance, as well as for all patients who seek care at hospitals treating a large proportion of patients who are uninsured or on Medicaid. Remedies for individual patients could include improved access to private insurance through employment or individual plans or improved reimbursement from Medicaid for this procedure. Strategies for patients at low-performing hospitals include selective referral to centers that perform mestastectomy more frequently when appropriate.
Collapse
Affiliation(s)
- Mark A Healy
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | |
Collapse
|
56
|
Gruenberger T, Beets G, Van Laethem JL, Rougier P, Cervantes A, Douillard JY, Figueras J, Gruenberger B, Haller DG, Labianca R, Maleux G, Roth A, Ducreux M, Schmiegel W, Seufferlein T, Van Cutsem E. Treatment sequence of synchronously (liver) metastasized colon cancer. Dig Liver Dis 2016; 48:1119-23. [PMID: 27375207 DOI: 10.1016/j.dld.2016.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 12/11/2022]
Abstract
No standards for staging, systemic therapy or the timing of an operation are defined for patients newly diagnosed with synchronous metastases and a primary in the colon. An expert group of radiologists, medical, radiation and surgical oncologists therefore came together to discuss staging and treatment sequence for these patients and came up with a recommendation based on current evidence of potential therapeutic options. The discussion was organized to debate recommendations centred on 5 topics and therefore the position paper is built upon these titles and their subtitles.
Collapse
Affiliation(s)
| | - Geerard Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jean-Luc Van Laethem
- Department of Gastroenterology - GI Cancer Unit, Erasme University Hospital, Brussels, Belgium
| | | | - Andrés Cervantes
- Dept. Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | | | - Joan Figueras
- Hepato-biliary and Pancreatic Unit, Josep Trueta Hospital, Girona, Spain
| | - Birgit Gruenberger
- Department of Internal Medicine, Hospital of St. John of God, Vienna, Austria
| | - Daniel G Haller
- Abramson Cancer Center University of Pennsylvania, Philadelphia, USA
| | | | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium
| | - Arnaud Roth
- Oncology Department, Geneva University Hospitals, Switzerland
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Wolff Schmiegel
- Department of Medicine, Ruhr University Bochum, Knappschaftskrankenhaus, Germany
| | | | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KULeuven, Leuven, Belgium
| |
Collapse
|
57
|
Alawadi Z, Phatak UR, Hu CY, Bailey CE, You YN, Kao LS, Massarweh NN, Feig BW, Rodriguez-Bigas MA, Skibber JM, Chang GJ. Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer. Cancer 2016; 123:1124-1133. [PMID: 27479827 DOI: 10.1002/cncr.30230] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/27/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the safety of combination chemotherapy without primary tumor resection (PTR) in patients with stage IV colon cancer has been established, questions remain regarding a potential survival benefit with PTR. The objective of this study was to compare mortality rates in patients who had colon cancer with unresectable metastases who did and did not undergo PTR. METHODS An observational cohort study was conducted among patients with unresectable metastatic colon cancer identified from the National Cancer Data Base (2003-2005). Multivariate Cox regression analyses with and without propensity score weighting (PSW) were performed to compare survival outcomes. Instrumental variable analysis, using the annual hospital-level PTR rate as the instrument, was used to account for treatment selection bias. To account for survivor treatment bias, in situations in which patients might die soon after diagnosis from different reasons, a landmark method was used. RESULTS In the total cohort, 8641 of 15,154 patients (57%) underwent PTR, and 73.8% of those procedures (4972 of 6735) were at landmark. PTR was associated with a significant reduction in mortality using Cox regression (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.44-0.47) or PSW (HR, 0.46; 95% CI, 0. 44-0.49). However, instrumental variable analysis revealed a much smaller effect (relative mortality rate, 0.91; 95% CI, 0.87-0.96). Although a smaller benefit was observed with the landmark method using Cox regression (HR, 0.6; 95% CI, 0.55-0.64) and PSW (HR, 0.59; 95% CI, 0.54-0.64), instrumental variable analysis revealed no survival benefit (relative mortality rate, 0.97; 95% CI, 0.87-1.06). CONCLUSIONS Among patients with unresectable metastatic colon cancer, after adjustment for confounder effects, PTR was not associated with improved survival compared with systemic chemotherapy; therefore, routine noncurative PTR is not recommended. Cancer 2017;123:1124-1133. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Zeinab Alawadi
- Department of General Surgery, The University of Texas Health Science Center, Houston Texas.,Center for Surgical Trials and Evidence-Based Practice, The University of Texas Health Science Center, Houston Texas
| | - Uma R Phatak
- Department of General Surgery, The University of Texas Health Science Center, Houston Texas.,Center for Surgical Trials and Evidence-Based Practice, The University of Texas Health Science Center, Houston Texas
| | - Chung-Yuan Hu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Christina E Bailey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Lillian S Kao
- Department of General Surgery, The University of Texas Health Science Center, Houston Texas.,Center for Surgical Trials and Evidence-Based Practice, The University of Texas Health Science Center, Houston Texas
| | - Nader N Massarweh
- Department of Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston Texas
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Miguel A Rodriguez-Bigas
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - John M Skibber
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - George J Chang
- Center for Surgical Trials and Evidence-Based Practice, The University of Texas Health Science Center, Houston Texas.,Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston Texas
| |
Collapse
|
58
|
Outcomes of colon resection in patients with metastatic colon cancer. Am J Surg 2016; 212:264-71. [DOI: 10.1016/j.amjsurg.2016.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/22/2022]
|
59
|
Healy MA, Pradarelli JC, Krell RW, Regenbogen SE, Suwanabol PA. Variation in primary site resection practices for advanced colon cancer: a study using the National Cancer Data Base. Am J Surg 2016; 212:579-586. [PMID: 27506579 DOI: 10.1016/j.amjsurg.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/25/2016] [Accepted: 06/27/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment of metastatic colon cancer may be driven as much by practice patterns as by features of disease. To optimize management, there is a need to better understand what is determining primary site resection use. METHODS We evaluated all patients with stage IV cancers in the National Cancer Data Base from 2002 to 2012 (50,791 patients, 1,230 hospitals). We first identified patient characteristics associated with primary tumor resection. Then, we assessed nationwide variation in hospital resection rates. RESULTS Overall, 27,387 (53.9%) patients underwent primary site resection. Factors associated with resection included younger age, having less than 2 major comorbidities, and white race (P < .001). Nationwide, hospital-adjusted primary tumor resection rates ranged from 26.0% to 87.8% with broad differences across geographical areas and hospital accreditation types. CONCLUSIONS There is statistically significant variation in hospital rates of primary site resection. This demonstrates inconsistent adherence to guidelines in the presence of conflicting evidence regarding resection benefit.
Collapse
Affiliation(s)
- Mark A Healy
- Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA.
| | | | - Robert W Krell
- Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA
| | - Scott E Regenbogen
- Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA
| |
Collapse
|
60
|
He WZ, Rong YM, Jiang C, Liao FX, Yin CX, Guo GF, Qiu HJ, Zhang B, Xia LP. Palliative primary tumor resection provides survival benefits for the patients with metastatic colorectal cancer and low circulating levels of dehydrogenase and carcinoembryonic antigen. CHINESE JOURNAL OF CANCER 2016; 35:58. [PMID: 27357402 PMCID: PMC4928252 DOI: 10.1186/s40880-016-0120-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/15/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND It remains controversial whether palliative primary tumor resection (PPTR) can provide survival benefits to the patients with metastatic colorectal cancer (mCRC) who have unresectable metastases. The aim of this study was to evaluate whether PPTR could improve the survival of patients with mCRC. METHODS We conducted a retrospective study on consecutive mCRC patients with unresectable metastases who were diagnosed at Sun Yat-sen University Cancer Center in Guangzhou, Guangdong, China, between January 2005 and December 2012. Overall survival (OS) and progression-free survival (PFS) after first-line chemotherapy failure were compared between the PPTR and non-PPTR patient groups. RESULTS A total of 387 patients were identified, including 254 who underwent PPTR and 133 who did not. The median OS of the PPTR and non-PPTR groups was 20.8 and 14.8 months (P < 0.001), respectively. The median PFS after first-line chemotherapy was 7.3 and 4.8 months (P < 0.001) in the PPTR and non-PPTR groups, respectively. A larger proportion of patients in the PPTR group (219 of 254, 86.2%) showed local progression compared with that of patients in the non-PPTR group (95 of 133, 71.4%; P < 0.001). Only patients with normal lactate dehydrogenase (LDH) levels and with carcinoembryonic antigen (CEA) levels <70 ng/mL benefited from PPTR (median OS, 22.2 months for the PPTR group and 16.2 months for the non-PPTR group; P < 0.001). CONCLUSIONS For mCRC patients with unresectable metastases, PPTR can improve OS and PFS after first-line chemotherapy and decrease the incidence of new organ involvement. However, PPTR should be recommended only for patients with normal LDH levels and with CEA levels <70 ng/mL.
Collapse
Affiliation(s)
- Wen-Zhuo He
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Yu-Ming Rong
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Chang Jiang
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Fang-Xin Liao
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Chen-Xi Yin
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Gui-Fang Guo
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Hui-Juan Qiu
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Bei Zhang
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| | - Liang-Ping Xia
- />State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
- />VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, 510060 Guangdong P. R. China
| |
Collapse
|
61
|
Managing the Primary Tumor with Unresectable Synchronous Colorectal Metastases. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
62
|
Ahmed S, Leis A, Chandra-Kanthan S, Fields A, Reeder B, Iqbal N, Haider K, Le D, Pahwa P. Surgical Management of the Primary Tumor in Stage IV Colorectal Cancer: A Confirmatory Retrospective Cohort Study. J Cancer 2016; 7:837-45. [PMID: 27162543 PMCID: PMC4860801 DOI: 10.7150/jca.14717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Observational studies have suggested that patients with stage IV colorectal cancer who undergo surgical resection of the primary tumor (SRPT) have better survival. Yet the results are not confirmed in the setting of a randomized controlled trial. Lack of randomization and failure to control prognostic variables such as performance status are major critiques to the findings of the observational studies. We previously have shown that SRPT, independent of chemotherapy and performance status, improves survival of stage IV CRC patients. The current study aims to validate our findings in patients with stage IV CRC who were diagnosed during the period of modern chemotherapy. METHODS A cohort of 569 patients with stage IV CRC diagnosed during 2006-2010 in the province of Saskatchewan was evaluated. Cox regression model was used for the adjustment of prognostic variables. RESULTS Median age was 69 years (59-95) and M: F was 1.4:1. Fifty-seven percent received chemotherapy, 91.4% received FOLFIRI or FOLFOX & 67% received a biologic agent. Median overall survival (OS) of patients who underwent SRPT and received chemotherapy was 27 months compared with 14 months of the non-resection group (p<0.0001). Median OS of patients who received all active agents and had SRPT was 39 months (95%CI: 25.1-52.9). On multivariate analysis, SRPT, hazard ratio (HR):0.44 (95%CI: 0.35-0.56), use of chemotherapy, HR: 0.33 (95%CI: 0.26-0.43), metastasectomy, HR: 0.43 (95%CI: 0.31-0.58), second line therapy, HR: 0.50 (95%CI: 0.35-0.70), and third line therapy, HR: 0.58 (95%CI: 0.41-0.83) were correlated with superior survival. CONCLUSIONS This study confirms our findings and supports a favorable association between SRPT and survival in patients with stage IV CRC who are treated with modern therapy.
Collapse
Affiliation(s)
- Shahid Ahmed
- 1. Saskatchewan Cancer Agency;; 2. Department of Oncology , University of Saskatchewan;; 3. Department of Community Health and Epidemiology, University of Saskatchewan
| | - Anne Leis
- 3. Department of Community Health and Epidemiology, University of Saskatchewan
| | | | | | - Bruce Reeder
- 3. Department of Community Health and Epidemiology, University of Saskatchewan
| | - Nayyer Iqbal
- 1. Saskatchewan Cancer Agency;; 2. Department of Oncology , University of Saskatchewan
| | - Kamal Haider
- 1. Saskatchewan Cancer Agency;; 2. Department of Oncology , University of Saskatchewan
| | - Duc Le
- 1. Saskatchewan Cancer Agency;; 2. Department of Oncology , University of Saskatchewan
| | - Punam Pahwa
- 3. Department of Community Health and Epidemiology, University of Saskatchewan;; 6. Division of Biostatistics, Department of Community Health and Epidemiology, University of Saskatchewan
| |
Collapse
|
63
|
Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer Without Metastasectomy is Associated With Improved Overall Survival Compared With Chemotherapy/Radiation Therapy Alone. Dis Colon Rectum 2016; 59:299-305. [PMID: 26953988 PMCID: PMC4785825 DOI: 10.1097/dcr.0000000000000546] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Controversy exists over whether resection of the primary tumor in stage IV colorectal cancer with inoperable metastases improves patient outcomes. OBJECTIVE The purpose of this study was to evaluate whether resection of the primary tumor without metastasectomy in patients with stage IV colorectal cancer is associated with improved overall survival compared with patients undergoing chemotherapy and/or radiation therapy alone. DESIGN This was a retrospective review of a multi-institutional dataset. SETTINGS This study was conducted in all participating commission on cancer (CoC)-accredited facilities. PATIENTS The 2003-2006 National Cancer Data Base was reviewed to identify patients with stage IV adenocarcinoma of the colon or rectum who underwent palliative treatment without curative intent, either in the form of surgical resection of the primary tumor without metastasectomy consisting of a colectomy or rectal resection with or without chemotherapy and/or radiation or chemotherapy and/or radiation alone. MAIN OUTCOME MEASURES Groups were compared for baseline characteristics. Overall survival was compared using Kaplan-Meier analysis before and after propensity matching with a 1:1 nearest-neighbor algorithm. RESULTS Of the 1446 patients included in the analysis, 231 (16%) underwent surgical resection of the primary tumor without metastasectomy. Surgical resection was associated with a significant survival benefit on unadjusted analysis (median survival, 9.2 vs. 7.6 months; p < 0.01). After propensity matching to adjust for nonrandom treatment selection, surgical resection continued to be associated with a significant survival benefit (median survival, 9.2 vs. 7.3 months; p < 0.01). LIMITATIONS This study was limited by the potential for selection bias regarding which patients received surgical resection. There was also a lack of data regarding the indication for operation, specifically whether a patient was symptomatic or asymptomatic before resection. The inability to account for tumor size or grade among patients who did not receive surgical resection was another limitation. CONCLUSIONS Surgical resection of the primary tumor without metastasectomy in patients with metastatic colorectal cancer is associated with improved survival as compared with chemotherapy/radiation therapy alone. Additional research is necessary to determine which patients may benefit from this intervention.
Collapse
|
64
|
Massarweh NN, Li LT, Sansgiry S, Berger DH, Anaya DA. Primary Tumor Resection and Multimodality Treatment for Patients with Metastatic Colon Cancer. Ann Surg Oncol 2016; 23:1815-23. [DOI: 10.1245/s10434-015-5073-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Indexed: 12/16/2022]
|
65
|
Wong SF, Wong HL, Field KM, Kosmider S, Tie J, Wong R, Tacey M, Shapiro J, Nott L, Richardson G, Cooray P, Jones I, Croxford M, Gibbs P. Primary Tumor Resection and Overall Survival in Patients With Metastatic Colorectal Cancer Treated With Palliative Intent. Clin Colorectal Cancer 2015; 15:e125-32. [PMID: 26803709 DOI: 10.1016/j.clcc.2015.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The survival impact of primary tumor resection in patients with metastatic colorectal cancer (mCRC) treated with palliative intent remains uncertain. In the absence of randomized data, the objectives of the present study were to examine the effect of primary tumor resection (PTR) and major prognostic variables on overall survival (OS) of patients with de novo mCRC. PATIENTS AND METHODS Consecutive patients from the Australian 'Treatment of Recurrent and Advanced Colorectal Cancer' registry were examined from June 2009 to March 2015. Univariate and multivariate Cox proportional hazards regression analyses were used to identify associations between multiple patient or clinical variables and OS. Patients with metachronous mCRC were excluded from the analyses. RESULTS A total of 690 patients de novo and 373 metachronous mCRC patients treated with palliative intent were identified. The median follow-up period was 30 months. The median age of de novo patients was 66 years; 57% were male; 77% had an Eastern Cooperative Oncology Group performance status of 0 to 1; and 76% had a colon primary. A total of 216 de novo mCRC patients treated with palliative intent underwent PTR at diagnosis and were more likely to have a colon primary (odds ratio [OR], 15.4), a lower carcinoembryonic antigen level (OR, 2.08), and peritoneal involvement (OR, 2.58; P < .001). On multivariate analysis, PTR at diagnosis in de novo patients was not associated with significantly improved OS (hazard ratio [HR], 0.82; 99% confidence interval [CI], 0.62-1.09; P = .068). PTR at diagnosis did not correlate with outcome in de novo patients with a colon primary (HR, 0.74; 99% CI, 0.54-1.01; P = .014) or a rectal primary (HR, 0.81; 99% CI, 0.27-2.44; P = .621). CONCLUSION For de novo mCRC patients treated with palliative intent, PTR at diagnosis does not significantly improve OS when adjusting for known major prognostic factors. The outcomes of randomized trials examining the survival impact of PTR are awaited.
Collapse
Affiliation(s)
- Shu Fen Wong
- Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia; Deakin University School of Medicine, Waurn Ponds, VIC, Australia.
| | - Hui Li Wong
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Kathryn M Field
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Suzanne Kosmider
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia; Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC, Australia
| | - Mark Tacey
- Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne EpiCentre, Parkville, VIC, Australia
| | | | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | | | - Prasad Cooray
- Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Ian Jones
- Department of Surgery, Colorectal Surgery Unit, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Matthew Croxford
- Department of Surgery, Western Hospital, Footscray, VIC, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| |
Collapse
|
66
|
Wilkinson KJ, Chua W, Ng W, Roohullah A. Management of asymptomatic primary tumours in stage IV colorectal cancer: Review of outcomes. World J Gastrointest Oncol 2015; 7:513-523. [PMID: 26691885 PMCID: PMC4678398 DOI: 10.4251/wjgo.v7.i12.513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 09/23/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare outcomes for patients presenting with stage IV colorectal cancer and an asymptomatic primary tumour, undergoing primary tumour resection (PTR) plus palliative chemotherapy vs primary chemotherapy up-front.
METHODS: A literature search was conducted using MEDLINE and EMBASE. The primary outcome was overall survival. Secondary outcomes included perioperative mortality, morbidity and delayed surgical intervention rates in patients undergoing PTR and subsequent complication rates in patients with an un-resected primary tumour. Tertiary outcomes included impact on systemic treatment and identification of prognostic factors relevant for survival in this cohort.
RESULTS: Twenty non-randomised studies met the inclusion criteria. Eleven studies included comparative overall survival data. Three studies showed an overall survival advantage for PTR, 7 studies showed no statistically significant advantage, and 1 study showed a significant worsening in survival in the surgical group. The perioperative mortality rate ranged from 0% to 8.5%, and post-operative morbidity rate from 10% to 35%, mainly minor complications that did not preclude subsequent chemotherapy. The rate of delayed primary-tumour related symptoms, most commonly obstruction, in patients with an un-resected primary tumour ranged from 3% to 46%. The strongest independent poor prognostic factor was extensive hepatic metastases, in addition to poor performance status, M1b stage and non-use of modern chemotherapy agents.
CONCLUSION: Based on the current literature, both PTR and up front chemotherapy appear appropriate initial management strategies, with a trend towards an overall survival advantage with PTR. The procedure has a low post-operative mortality, and most complications are transient and minor. The results of recruiting randomised trials are eagerly anticipated.
Collapse
|
67
|
Wancata LM, Banerjee M, Muenz DG, Haymart MR, Wong SL. Conditional survival in advanced colorectal cancer and surgery. J Surg Res 2015; 201:196-201. [PMID: 26850202 DOI: 10.1016/j.jss.2015.10.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/12/2015] [Accepted: 10/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent data show patients with advanced colorectal cancer (CRC) are surviving longer. What is unknown is how specific treatment modalities affect long-term survival. Conditional survival, or survival prognosis based on time already survived, is becoming an acceptable means of estimating prognosis for long-term survivors. We evaluated the impact of cancer-directed surgery on long-term survival in patients with advanced CRC. METHODS We used Surveillance, Epidemiology, and End Results data to identify 64,956 patients with advanced (Stage IV) CRC diagnosed from 2000-2009. Conditional survival estimates by stage, age, and cancer-directed surgery were obtained based on Cox proportional hazards regression model of disease-specific survival. RESULTS A total of 64,956 (20.1%) patients had advanced disease at the time of diagnosis. The proportion of those patients who underwent cancer-directed surgery was 65.1% (n = 42,176). Cancer-directed surgery for patients with advanced stage disease was associated with a significant improvement in traditional survival estimates compared to patients who did not undergo surgery (hazard ratio = 2.22 [95% confidence interval, 2.17-2.27]). Conditional survival estimates show improvement in conditional 5-y disease-specific survival across all age groups, demonstrating sustained survival benefits for selected patients with advanced CRC. CONCLUSIONS Five-year disease-specific conditional survival improves dramatically over time for selected patients with advanced CRC who undergo cancer-directed surgery. This information is important in determining long-term prognosis and will help inform treatment planning for advanced CRC.
Collapse
Affiliation(s)
- Lauren M Wancata
- Department of Surgery, University of Michigan, North Campus Research Complex, Ann Arbor, Michigan
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Daniel G Muenz
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Megan R Haymart
- Department of Medicine, Division of Metabolism, Endocrinology & Diabetes & Hematology/Oncology, University of Michigan, North Campus Research Complex, Ann Arbor, Michigan
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| |
Collapse
|
68
|
Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection. Int J Colorectal Dis 2015; 30:1357-63. [PMID: 26149942 DOI: 10.1007/s00384-015-2305-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the rate of complications from the primary tumour (CPT) requiring surgical or endoscopic intervention during chemotherapy treatment in patients with incurable synchronous stage IV colorectal cancer, the possibility of predicting such complications and their influence on survival. METHODS One hundred and twenty-five patients were initially treated with chemotherapy. Patients were grouped on the basis of appearance or not of CPT. We assessed the relation between age, gender, carcinoembryonic antigen (CEA) level, primary tumour location, alkaline phosphatase level, unilobar or bilobar liver involvement, presence of peritoneal carcinomatosis, the number of sites of metastatic disease, the addition of target therapies to chemotherapy, the ability to traverse the tumour with an endoscope and the appearance of complications due to the primary tumour and overall survival. RESULTS Mean age was 64.9 years, and 89 patients were men. Over a mean of 234 days, 25 patients (20 %) developed a CPT. Eighteen patients required surgery, and seven were treated exclusively by an endoscopic procedure. Mean survival was 15.8 months. We found a statistically relevant correlation between the inability to traverse the tumour with an endoscope and the occurrence of a CPT. There was no statistical differences in survival between both groups, but patients receiving target therapies had better survival. CONCLUSION Twenty percent of patients will suffer a CPT during chemotherapy treatment. The inability to pass the tumour with an endoscope can predict the CPT. Survival was only related to the addition of target therapies to chemotherapy.
Collapse
|
69
|
Turner N, Tran B, Tran PV, Sinnathamby M, Wong HL, Jones I, Croxford M, Desai J, Tie J, Field KM, Kosmider S, Bae S, Gibbs P. Primary Tumor Resection in Patients With Metastatic Colorectal Cancer Is Associated With Reversal of Systemic Inflammation and Improved Survival. Clin Colorectal Cancer 2015; 14:185-91. [DOI: 10.1016/j.clcc.2015.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/17/2015] [Accepted: 02/26/2015] [Indexed: 12/31/2022]
|
70
|
Feasibility of the liver-first approach for patients with initially unresectable and not optimally resectable synchronous colorectal liver metastases. Surg Today 2015; 46:721-8. [DOI: 10.1007/s00595-015-1242-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/21/2015] [Indexed: 02/07/2023]
|
71
|
Imbulgoda A, MacLean A, Heine J, Drolet S, Vickers MM. Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review. Can J Surg 2015; 58:167-71. [PMID: 25799132 DOI: 10.1503/cjs.013014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Self-expanding metal stents (SEMS) are increasingly used in the treatment of malignant large bowel obstruction in the setting of inoperable colorectal cancer. Perforation is a well-known complication associated with these devices. The addition of the vascular endothelial growth factor inhibitor bevacizumab is suspected to increase the rate, but the extent of the increase is not known. METHODS We retrospectively reviewed the records of patients receiving SEMS in tertiary hospitals in Calgary, Alta., between October 2001 and January 2012. RESULTS We reviewed the records of 87 patients with inoperable colorectal cancer who received SEMS during our study period. Nine perforations occurred in total: 4 of 30 (13%) patients who received no chemotherapy, 3 of 47 (6%) who received chemotherapy but no bevacizumab, and 2 of 10 (20%) who received chemotherapy and bevacizumab. These two patients received bevacizumab with FOLFIRI after SEMS placement, and they had peritoneal disease. CONCLUSION Our case series and other studies suggest that bevacizumab may increase the risk of colonic perforation in the setting of SEMS. Caution should be used when combining these therapies.
Collapse
Affiliation(s)
- Amal Imbulgoda
- The Department of Oncology, University of Calgary, Calgary, Alta
| | - Anthony MacLean
- The Department of Surgery, University of Calgary, Calgary, Alta
| | - John Heine
- The Department of Surgery, University of Calgary, Calgary, Alta
| | | | - Michael M Vickers
- The Department of Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, Ont
| |
Collapse
|
72
|
Shapiro M, Rashid NU, Whang EE, Boosalis VA, Huang Q, Yoon C, Saund MS, Gold JS. Trends and predictors of resection of the primary tumor for patients with stage IV colorectal cancer. J Surg Oncol 2015; 111:911-6. [PMID: 25919984 DOI: 10.1002/jso.23906] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/28/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Over 130,000 patients are diagnosed with colorectal cancer annually, with approximately 20% presenting with unresectable metastatic disease. Recent consensus guidelines recommend against primary tumor resection for asymptomatic patients with unresectable metastases. Our goal was to examine the trends and predictors of surgical resection. METHODS Cases of colorectal cancer with synchronous metastases diagnosed between 1988-2010 were identified using the Surveillance, Epidemiology and End Results (SEER) Database. Associations between resection and clinicopathologic variables were sought using univariate and multivariate logistic regression. RESULTS Overall, 68% of patients with synchronous metastatic colorectal cancer underwent primary tumor resection. Resection rates were as high as 76% in the earliest time period (1988-1992) and steadily dropped to 60% in the most recent period (2008-2010). Socioeconomic factors associated with resection on univariate analysis included age, race, gender, marital status, insurance status, and geographic region. Clinicopathologic characteristics associated with resection included tumor location, grade, size, and CEA level. In the multivariate model, gender, geographic region, insurance status, tumor location, grade and CEA level were independent predictors of primary tumor resection. CONCLUSIONS Surgical resection of the primary site remains common practice for patients with synchronous metastatic colorectal cancer. Treatment disparities are associated with socioeconomic as well as clinicopathologic factors.
Collapse
Affiliation(s)
- Mia Shapiro
- Surgery Services, VA Boston Healthcare System, Harvard Medical School, West Roxbury, Massachusetts; VA Boston Healthcare System, Harvard Medical School, West Roxbury, Massachusetts
| | | | | | | | | | | | | | | |
Collapse
|
73
|
Adam R, de Gramont A, Figueras J, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Teh C, Tejpar S, Van Cutsem E, Vauthey JN, Påhlman L. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 2015; 41:729-41. [PMID: 26417845 DOI: 10.1016/j.ctrv.2015.06.006] [Citation(s) in RCA: 353] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 02/07/2023]
Abstract
An international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected ⩽12months and >12months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.
Collapse
Affiliation(s)
- René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France.
| | | | - Joan Figueras
- Hepato-biliary and Pancreatic Surgery Unit, Department of Surgery, Dr Josep Trueta Hospital, Institut d'Investigació Biomèdica (IDIBGi), Girona, Spain.
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, University of Tokyo, Tokyo, Japan.
| | - Francis Kunstlinger
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France.
| | - Evelyne Loyer
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| | - Graeme Poston
- Surgery Department, Aintree University Hospital, School of Translational Studies, University of Liverpool, Liverpool, UK.
| | - Philippe Rougier
- Digestive Oncology Department, Hôpital Européen Georges Pompidou, University Paris V-René Descartes and AP-HP Paris, France.
| | - Laura Rubbia-Brandt
- Pathology Department, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland.
| | | | - Catherine Teh
- Liver Centre and Department of Surgery, National Kidney & Transplant Institute, Quezon City, Philippines.
| | - Sabine Tejpar
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| | - Lars Påhlman
- Department of Surgical Science, Uppsala University Hospital, Uppsala, Sweden.
| | | |
Collapse
|
74
|
Current controversies in the management of metastatic colorectal cancer. Cancer Chemother Pharmacol 2015; 76:659-77. [DOI: 10.1007/s00280-015-2808-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/12/2015] [Indexed: 12/16/2022]
|
75
|
Neugut AI, Gelmann EP. Treatment of the Prostate in the Presence of Metastases: Lessons from Other Solid Tumors. Eur Urol 2015; 69:795-6. [PMID: 26099904 DOI: 10.1016/j.eururo.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/04/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Alfred I Neugut
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Edward P Gelmann
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
76
|
Dawood S, Sirohi B, Shrikhande SV, Toh HC, Eng C. Potential Prognostic Impact of Baseline CEA Level and Surgery of Primary Tumor Among Patients with Synchronous Stage IV Colorectal Cancer: A Large Population Based Study. Indian J Surg Oncol 2015; 6:198-206. [PMID: 27217664 DOI: 10.1007/s13193-015-0419-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 05/19/2015] [Indexed: 12/30/2022] Open
Abstract
Prognostic role of surgical resection of the primary tumor and baseline CEA among patients with synchronous stage IV colorectal cancer (CRC) remains an area of debate. The objective of this study was to determine the prognostic value of baseline CEA and surgical resection of the primary among patients with synchronous stage IV CRC in the era of modern chemotherapy and biologic therapy. The Surveillance, Epidemiology and End Results Registry was searched to identify patients with synchronous stage IV CRC diagnosed between 2004 and 2009. Colorectal-cancer-specific survival (CCS) was estimated using the Kaplan-Meier product limit method. Cox models were fitted to assess the multivariable relationship of various patient and tumor characteristics and CCS. Three hundred thirty-three thousand, three hundred ninety nine patients were identified in the SEER registry. Median CCS among patients with their primary tumor removed was 21 M vs. 7 M (primary intact) respectively (p < 0.001). Median CCS among patients who had an elevated vs. non-elevated baseline CEA level was 14 M vs. 24 M respectively (p < 0.0001). By multivariable analysis, patients with an elevated baseline CEA had a 56 % increased risk of death from CRC compared to those with a non-elevated CEA level (HR = 1.56, 95%CI 1.47-1.65, p < 0.0001). Similarly patients who underwent surgical resection of the primary tumor had a 33 % decreased risk of death from CRC compared to those who did not (HR = 0.61, 95%CI 0.54-0.69, p < 0.0001). In our review of this large population SEER based study, an elevated baseline CEA level and surgical resection of the primary tumor among patients with synchronous stage IV CRC appeared to impact survival outcomes. Prospective validation of these results in a surgically unresectable patient population will be required.
Collapse
Affiliation(s)
- Shaheenah Dawood
- Department of Medical Oncology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Bhawna Sirohi
- Department of Medical Oncology, Mazumdar Shaw Cancer Centre, Narayana Health, Bangalore, India
| | | | - Han-Chong Toh
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Cathy Eng
- Department of GI Medical Oncology, MD Anderson Cancer Center, Houston, TX USA
| |
Collapse
|
77
|
Ahmed S, Fields A, Pahwa P, Chandra-Kanthan S, Zaidi A, Le D, Haider K, Reeder B, Leis A. Surgical Resection of Primary Tumor in Asymptomatic or Minimally Symptomatic Patients With Stage IV Colorectal Cancer: A Canadian Province Experience. Clin Colorectal Cancer 2015; 14:e41-7. [PMID: 26140732 DOI: 10.1016/j.clcc.2015.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/29/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical resection of the primary tumor in patients with stage IV colorectal cancer (CRC) remains controversial. Survival benefit reported in the literature has been attributed to the selection of younger and healthier patients with good performance status. We have recently reported that resection of the primary tumor improved survival of patients with stage IV CRC. In this study we examined survival benefit of surgery in patients with asymptomatic or minimally symptomatic primary tumor. PATIENTS AND METHODS A cohort of patients with stage IV CRC and asymptomatic or minimally symptomatic primary tumor, who were diagnosed during the period of 1992 to 2005, in the province of Saskatchewan Canada, was evaluated. The Kaplan-Meier method was used to determine survival. A multivariate Cox proportional hazard regression analysis was performed to determine prognostic importance of resection of primary tumor. A test for interaction was performed for resection of primary tumor and other important clinicopathological variables. RESULTS A total of 834 patients with a median age of 70 years (range, 22-93) and male:female ratio of 58:42 were identified. Among them 521 (63%) patients underwent surgery and 361 (43.3%) received chemotherapy. Patients who underwent surgery and received any chemotherapy had a median overall survival of 19.7 months (95% confidence interval [CI], 16.9-22.6) compared with 8.4 months (95% CI, 6.9-10.0) if they did not have surgery (P < .0001). In multivariate analysis, 5-fluorouracil-based chemotherapy (hazard ratio [HR], 0.43; 95% CI, 0.36-0.53), surgical resection of the primary tumor (HR, 0.47; 95% CI, 0.39-0.57), metastasectomy (HR, 0.48; 95% CI, 0.38-0.62), and second-line chemotherapy (HR, 0.72; 95% CI, 0.58-0.92) were correlated with superior survival. A test for interaction between ≥ 1 metastatic sites and surgery was significant, which suggests a larger benefit of surgery in patients with stage IVA disease. CONCLUSION Results of this large population-based cohort study suggest that resection of the primary tumor in asymptomatic or minimally symptomatic patients with stage IV CRC improved survival independent of other prognostic variables. The benefit was more pronounced in stage IVA disease.
Collapse
Affiliation(s)
- Shahid Ahmed
- Department of Oncology, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Anthony Fields
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Punam Pahwa
- Department of Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Adnan Zaidi
- Department of Oncology, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Duc Le
- Department of Oncology, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kamal Haider
- Department of Oncology, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bruce Reeder
- Department of Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anne Leis
- Department of Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
78
|
Petrelli F, Coinu A, Ghilardi M, Cabiddu M, Zaniboni A, Barni S. Efficacy of oxaliplatin-based chemotherapy + bevacizumab as first-line treatment for advanced colorectal cancer: a systematic review and pooled analysis of published trials. Am J Clin Oncol 2015; 38:227-33. [PMID: 25806713 DOI: 10.1097/coc.0b013e3182a2d7b8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Oxaliplatin and either capecitabine or infusional/bolus 5-fluorouracil (5FU)-based chemotherapy + bevacizumab (XELOX + B and FOLFOX + B) represent 2 of the approved first-line treatments for advanced colorectal cancer (CRC). However, the addition of B did not offer a survival benefit compared with FOLFOX/XELOX alone in the phase III, NO16966 trial. The aim of this review was to aggregate all published data on the efficacy of XELOX and FOLFOX-B in prospective and retrospective studies as first-line therapy for stage IV CRC. METHODS We performed a systematic review, through PubMed and EMBASE, of all published studies exploring the efficacy of fluoropyrimidines + oxaliplatin + B-based chemotherapy as first-line chemotherapy in advanced CRC patients. Pooled estimates of the response rates, weighted medians of progression-free survival, and overall survival from all FOLFOX + B and XELOX + B arms were calculated. RESULTS A total of 25 studies were retrieved, with a total of 7878 patients. Overall, the pooled response rates (n=20 publications) was 49.1%. The median progression-free survival and overall survival (n=21 and 22 publications, respectively) were 10.3 and 23.7 months, respectively. The pooled median rate of surgical resection of metastases (n=13 publications) was 14%. CONCLUSIONS XELOX + B and FOLFOX + B are active combinations as first-line treatment of advanced CRC. The efficacy is confirmed for the first time from this pooled analysis of 25 trials. Both the XELOX + B and the FOLFOX + B arms represent 2 of the cornerstone combinations when B is used as first-line therapy.
Collapse
Affiliation(s)
- Fausto Petrelli
- *Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio (BG) †UO Oncologia, Dipartimento Oncologico, Istituto Ospedaliero Fondazione Poliambulanza, Brescia (BS), Italy
| | | | | | | | | | | |
Collapse
|
79
|
Niitsu H, Hinoi T, Shimomura M, Egi H, Hattori M, Ishizaki Y, Adachi T, Saito Y, Miguchi M, Sawada H, Kochi M, Mukai S, Ohdan H. Up-front systemic chemotherapy is a feasible option compared to primary tumor resection followed by chemotherapy for colorectal cancer with unresectable synchronous metastases. World J Surg Oncol 2015; 13:162. [PMID: 25908502 PMCID: PMC4426172 DOI: 10.1186/s12957-015-0570-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/04/2015] [Indexed: 12/30/2022] Open
Abstract
Background In stage IV colorectal cancer (CRC) with unresectable metastases, whether or not resection of the primary tumor should be indicated remains controversial. We aim to determine the impact of primary tumor resection on the survival of stage IV CRC patients with unresectable metastases. Methods We retrospectively investigated 103 CRC patients with stage IV colorectal cancer with metastases, treated at Hiroshima University Hospital between 2007 and 2013. Of these, those who had resectable primary tumor but unresectable metastases and received any chemotherapy were included in the study. We analyzed the overall survival (OS) and short-term outcomes between the patients who received up-front systemic chemotherapy (USC group) and those who received primary tumor resection followed by chemotherapy (PTR group). Results Of the 57 included patients, 15 underwent USC and 42 PTR. The median survival times were 13.4 and 23.9 months in the USC and PTR groups, respectively (P = 0.093), but multivariate analysis for the overall survival showed no significant difference between the two groups (hazard ratio, 1.30; 95% confidence interval (CI), 0.60 to 2.73, P = 0.495). In the USC group, the disease control rate of primary tumor was observed in 12 patients (80.0%), but emergency laparotomy was required for 1 patient. Morbidity in the PTR group was observed in 18 cases (42.9%). Conclusions The overall survival did not differ significantly between the USC and PTR groups. USC may help avoid unnecessary resection and consequently the high morbidity rate associated with primary tumor resection for stage IV CRC with unresectable metastases.
Collapse
Affiliation(s)
- Hiroaki Niitsu
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Takao Hinoi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Manabu Shimomura
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Minoru Hattori
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Yasuyo Ishizaki
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Tomohiro Adachi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Yasufumi Saito
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Masashi Miguchi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Hiroyuki Sawada
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Masatoshi Kochi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Shoichiro Mukai
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| |
Collapse
|
80
|
Ohhara Y, Suenaga M, Matsusaka S, Shinozaki E, Mizunuma N, Yamaguchi T. Comparison between three oxaliplatin-based regimens with bevacizumab in patients with metastatic colorectal cancer. Onco Targets Ther 2015; 8:529-37. [PMID: 25767397 PMCID: PMC4354450 DOI: 10.2147/ott.s77190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A previous pivotal Phase III study (NO16966) demonstrated the benefit of the addition of bevacizumab (BV) to oxaliplatin-based regimens in metastatic colorectal cancer (MCRC). Our study evaluated the safety and efficacy of three oxaliplatin-based chemotherapy regimens (FOLFOX4 [intravenous twice-bolus and twice-infusional 5-fluorouracil/folinic acid plus oxaliplatin], mFOLFOX6 [intravenous once-bolus and once-infusional 5-fluorouracil/folinic acid plus oxaliplatin], and XELOX [capecitabine plus oxaliplatin]) plus BV in the first-line treatment of MCRC patients. METHODS Patients with MCRC who started treatment between June 2007 and September 2010 were evaluated in this retrospective cohort study. We also evaluated early objective tumor response (EOTR) within 12 weeks, which was defined as a relative change of ≥30% in the sum of the longest diameters of target lesions when compared with baseline. The primary study endpoints were progression-free survival (PFS) and response rate. RESULTS A total of 185 patients received the following chemotherapy: FOLFOX4 + BV (FF4 arm, n=85), mFOLFOX6 + BV (FF6 arm, n=40), and XELOX + BV (XELOX arm, n=60). The overall response rates were 61.2%, 72.5%, and 75.0% (95% confidence interval: 50.6%-71.8%, 58.0%-87.0%, and 63.7%-86.3%). Median PFS was 18.0, 15.5, and 13.7 months, respectively (log-rank: P=0.254; data cut-off: May 2013). Patients with EOTR (n=117) had significantly better PFS than those without-EOTR (n=68) (17.5 versus 12.7 months, P=0.004). CONCLUSION This study suggests that these three BV plus oxaliplatin-based treatments might have comparable benefit in terms of tumor response and PFS. Moreover, EOTR may be a predictive factor for PFS in patients with MCRC.
Collapse
Affiliation(s)
- Yoshihito Ohhara
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan ; Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Mitsukuni Suenaga
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Matsusaka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Shinozaki
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nobuyuki Mizunuma
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiharu Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
81
|
|
82
|
Krell RW, Regenbogen SE, Wong SL. Variation in hospital treatment patterns for metastatic colorectal cancer. Cancer 2015; 121:1755-61. [PMID: 25640016 DOI: 10.1002/cncr.29253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/26/2014] [Accepted: 12/24/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are many treatment options for metastatic colorectal cancer (CRC). However, to the authors' knowledge, national treatment patterns for metastatic CRC, and the stability of hospital treatment patterns over time, have not been well described. METHODS Data from the 2006 through 2011 National Cancer Data Base were used to study adults with newly diagnosed metastatic CRC (84,161 patients from 1051 hospitals). Using hierarchical models, the authors characterized hospital volume in the use of different treatment modalities (primary site resection, metastatic site resection, chemotherapy, and palliative care). The authors then assessed variation in the receipt of treatment according to the hospitals' relative volume of services used. Finally, the extent to which hospital treatment patterns changed over the past decade was examined. RESULTS Overall use of volume of services varied widely (5.0% in the hospitals with low volumes of service to 22.3% in the hospitals with high volumes of service). As hospitals' volumes of services increased, adjusted rates of metastatic site surgery (6.6% to 30.8%; P<.001) and multiagent chemotherapy (37.8% to 57.4%; P<.001) use increased, but primary site resection demonstrated little variation (56.8% vs 59.5%; P = .024). It is interesting to note that use of palliative care also increased (8.1% to 11.3%; P = .002). Hospital treatment patterns did not change over time, with hospitals with high volumes of service consistently using more metastatic site resection and multiagent chemotherapy than hospitals with low volumes of service. CONCLUSIONS There is wide variation in hospital treatment patterns for patients with metastatic CRC, and these patterns have been stable over time. It appears that much of the approach for metastatic CRC treatment depends on the hospital in which the patient presents.
Collapse
Affiliation(s)
- Robert W Krell
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Sandra L Wong
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
83
|
Abstract
Treatment of colorectal cancer is becoming more uniform, with wider acceptance of standardized guidelines. However, areas of controversy exist where the appropriate treatment is not clear, including: should a segmental colectomy or a more extensive resection be performed in hereditary nonpolyposis colorectal cancer? should an asymptomatic primary cancer be resected in the presence of unresectable metastatic disease? what is the role of extended lymph node resection in colon and rectal cancer? are there clinically significant benefits for a robotic approach to colorectal resection versus a laparoscopic approach? This chapter will examine these issues and discuss how they may be resolved.
Collapse
|
84
|
Manceau G, Dubreuil O, Karoui M. Forme métastatique non résécable : quid du primitif ? ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
85
|
Faron M, Pignon JP, Malka D, Bourredjem A, Douillard JY, Adenis A, Elias D, Bouché O, Ducreux M. Is primary tumour resection associated with survival improvement in patients with colorectal cancer and unresectable synchronous metastases? A pooled analysis of individual data from four randomised trials. Eur J Cancer 2014; 51:166-76. [PMID: 25465185 DOI: 10.1016/j.ejca.2014.10.023] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/14/2014] [Accepted: 10/23/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the impact on survival of primary tumour resection in patients with unresectable synchronous metastases from colorectal cancer (CRC). SUMMARY BACKGROUND DATA Primary tumour resection in this setting remains controversial. PATIENTS AND METHODS We retrieved individual data of 1155 patients with metastatic CRC included in four first-line chemotherapy trials: Fédération Francophone de Cancérologie Digestive (FFCD)-9601, FFCD-2000-05, Actions Concertées dans les cancers COloRectaux et Digestifs (ACCORD)-13, and ML-16987. Patients with unresectable synchronous metastases were eligible for this study. We used univariate and multivariate analyses (Cox models stratified on the trial) to assess the impact of primary tumour resection and other potential prognostic variables on overall survival (OS) (the primary endpoint). RESULTS Amongst the 1155 patients, 810 patients met the inclusion criteria and 59% (n = 478) underwent resection of their primary tumour, prior to trial entry (resection group). Compared to patients in the non-resection group (n =3 32 [41%]), those in the resection group were more likely to have a colonic primary, lower baseline carcinoembryonic antigen (CEA) and alkaline phosphatase levels, and normal white-blood-cell count (p < 0.001 each). Primary tumour resection was independently associated to better OS in multivariate analysis (hazard ratio (HR), 0.63 [0.53-0.75]; p < 0.001, with a more favourable impact of resection on OS in case of rectal primary and low CEA level. Primary tumour resection was also independently associated to a better progression-free survival in multivariate analysis (HR, 0.82 [0.70-0.95]; p < 0.001). CONCLUSION Primary tumour resection was independently associated to a better OS in patients with CRC and unresectable synchronous metastases.
Collapse
Affiliation(s)
- Matthieu Faron
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Jean-Pierre Pignon
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.
| | - David Malka
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Jean-Yves Douillard
- Department of Medical and Translational Research, Centre René Gauducheau, Saint-Herblain, France
| | - Antoine Adenis
- Department of Urologic and Digestive Oncology, Centre Oscar Lambret, Lille, France
| | - Dominique Elias
- Department of Visceral Surgery, Gustave Roussy, Villejuif, France
| | - Olivier Bouché
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Robert Debré, Reims, France
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| |
Collapse
|
86
|
Kelly M, Spolverato G, Lê G, Mavros M, Doyle F, Pawlik T, Winter D. Synchronous colorectal liver metastasis: A network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J Surg Oncol 2014; 111:341-51. [DOI: 10.1002/jso.23819] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/07/2014] [Indexed: 12/12/2022]
Affiliation(s)
- M.E. Kelly
- Department of Surgery; St Vincent's University Hospital; Dublin Ireland
| | - G. Spolverato
- Department of Surgery; Johns Hopkins; Baltimore Maryland
| | - G.N. Lê
- Department of Surgery; St Vincent's University Hospital; Dublin Ireland
| | - M.N. Mavros
- Department of Surgery; Johns Hopkins; Baltimore Maryland
| | - F. Doyle
- Division of Population Health Sciences; Royal College of Surgeons Ireland; Dublin Ireland
| | - T.M. Pawlik
- Department of Surgery; Johns Hopkins; Baltimore Maryland
| | - D.C. Winter
- Department of Surgery; St Vincent's University Hospital; Dublin Ireland
| |
Collapse
|
87
|
Mi K, Kalady MF, Quintini C, Khorana AA. Integrating systemic and surgical approaches to treating metastatic colorectal cancer. Surg Oncol Clin N Am 2014; 24:199-214. [PMID: 25444476 DOI: 10.1016/j.soc.2014.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multiple new treatment options for metastatic colorectal cancer have been developed over the past 2 decades, including conventional chemotherapy and agents directed against vascular endothelial growth factor and epidermal growth factor receptor. Combination regimens, integrated with surgical approaches, have led to an increase in median survival, and a minority of patients with resectable disease can survive for years. Clinical decision-making therefore requires a strategic, biomarker-based multidisciplinary approach to maximize life expectancy and quality of life. This review describes systemic approaches to the treatment of patients with metastatic colorectal cancer, including integration with liver resection, other liver-directed therapies, and primary resection.
Collapse
Affiliation(s)
- Kaihong Mi
- Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Matthew F Kalady
- Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Digestive Disease Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Cristiano Quintini
- Digestive Disease Institute, HPB and Liver Transplant Program, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alok A Khorana
- Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
88
|
The role of palliative resection for asymptomatic primary tumor in patients with unresectable stage IV colorectal cancer. Dis Colon Rectum 2014; 57:1049-58. [PMID: 25101600 DOI: 10.1097/dcr.0000000000000193] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The prognostic role of surgical resection of primary tumors is not well established in patients with asymptomatic unresectable stage IV colorectal cancer. OBJECTIVE The aims of this study were to reveal the prognostic role of surgical resection of primary tumors and to define prognostic factors affecting long-term oncological outcomes in patients with asymptomatic unresectable synchronous metastases. DESIGN This study was a retrospective analysis of prospectively collected data. PATIENTS Between 2000 and 2008, a total of 416 patients with asymptomatic unresectable stage IV colorectal cancer were analyzed with propensity score matching. MAIN OUTCOME MEASURES Prematching baseline characteristics were compared by bivariate analysis, and 113 pairs were selected after 1:1 matching with propensity scores estimated from logistic regression. The primary end point was overall survival. RESULTS Among 416 patients, 218 (52.4%) underwent palliative resection of the primary tumor. Before propensity score matching, palliative resection resulted in a better survival rate than nonresection in univariate analysis (p < 0.001), but not in multivariate analysis (p = 0.08). After matching, the 5-year overall survival rate was significantly lower for patients with peritoneal metastasis and clinical M1b stage tumors in univariate analysis (p = 0.004 and p = 0.02). However, neither peritoneal metastasis nor clinical M1b stage showed any prognostic significance in multivariate analysis. The overall 5-year survival rate of the postmatching group was 4.9% and 3.5% in the palliative resection and nonresection groups. Consequently, palliative resection was not associated with a significant increase in survival compared with nonresection (p = 0.27). A subgroup analysis performed according to the site of metastasis also did not show any significant survival benefit of palliative resection after matching. LIMITATIONS Selection bias and potential confounders were limitations of this study. CONCLUSIONS Resection of the primary tumor in patients with asymptomatic unresectable stage IV colorectal cancer was not associated with an improvement in overall survival after propensity score matching.
Collapse
|
89
|
Price TJ, Segelov E, Burge M, Haller DG, Tebbutt NC, Karapetis CS, Punt CJA, Pavlakis N, Arnold D, Gibbs P, Shapiro JD. Current opinion on optimal systemic treatment for metastatic colorectal cancer: outcome of the ACTG/AGITG expert meeting ECCO 2013. Expert Rev Anticancer Ther 2014; 14:1477-93. [PMID: 25138900 DOI: 10.1586/14737140.2014.949678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The treatment of metastatic colorectal cancer has evolved greatly in the last 15 years, involving combined chemotherapy protocols and, in more recent times, new biologic agents. Clinical benefit from the use of targeted therapy with bevacizumab, aflibercept, cetuximab, panitumumab and regorafenib in the treatment of metastatic colorectal cancer is now well established with median overall survival accepted as over 24 months, and with super selection for extended RAS patients higher again. The optimal timing of treatment options requires careful consideration of predictive biomarkers, and importantly the potential for interactions, to derive the maximal benefit. A group of colorectal subspecialty medical oncologists from Australia, the USA, the Netherlands and Germany met during ECCO 2013 to discuss current practice. Subsequent new data from the American Society of Clinical Oncology were also reviewed. This article reviews the evidence discussed in support of modern treatments for colorectal cancer and the decision-making behind the treatment choices, with their benefits and risks.
Collapse
Affiliation(s)
- Timothy J Price
- The Queen Elizabeth Hospital, Adelaide Colorectal Tumour Group and University of Adelaide, Adeaide, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
90
|
Kube R, Mroczkowski P. [Metastasized colonic cancer. When are there no indications for primary resection?]. Chirurg 2014; 86:148-53. [PMID: 24969343 DOI: 10.1007/s00104-014-2765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The determination of an optimal treatment protocol for colonic cancer with synchronous incurable metastases remains a challenge, especially if the primary tumor is asymptomatic. Available data on whether resection of the primary tumor means a benefit or a danger to the patient are limited and inhomogeneous. A survival benefit could be shown only in retrospective studies with a bias against primary chemotherapy. The important question of the quality of life (QOL) remains completely unanswered in this respect. There are numerous groups and guidelines in favor of a primary palliative chemotherapy for these patients, possibly intensified by antibodies. The results of the currently ongoing randomized multicenter SYNCHRONUS study will deliver objective data facilitating the decision-making process with respect to the indications for resection of the primary tumor or primary chemotherapy.
Collapse
Affiliation(s)
- R Kube
- Klinik für Chirurgie, Carl-Thiem-Klinikum Cottbus, Thiemstr. 111, 03048, Cottbus, Deutschland,
| | | |
Collapse
|
91
|
Mestier LD, Manceau G, Neuzillet C, Bachet JB, Spano JP, Kianmanesh R, Vaillant JC, Bouché O, Hannoun L, Karoui M. Primary tumor resection in colorectal cancer with unresectable synchronous metastases: A review. World J Gastrointest Oncol 2014; 6:156-69. [PMID: 24936226 PMCID: PMC4058723 DOI: 10.4251/wjgo.v6.i6.156] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 04/08/2014] [Accepted: 05/13/2014] [Indexed: 02/05/2023] Open
Abstract
At the time of diagnosis, 25% of patients with colorectal cancer (CRC) present with synchronous metastases, which are unresectable in the majority of patients. Whether primary tumor resection (PTR) followed by chemotherapy or immediate chemotherapy without PTR is the best therapeutic option in patients with asymptomatic CRC and unresectable metastases is a major issue, although unanswered to date. The aim of this study was to review all published data on whether PTR should be performed in patients with CRC and unresectable synchronous metastases. All aspects of the management of CRC were taken into account, especially prognostic factors in patients with CRC and unresectable metastases. The impact of PTR on survival and quality of life were reviewed, in addition to the characteristics of patients that could benefit from PTR and the possible underlying mechanisms. The risks of both approaches are reported. As no randomized study has been performed to date, we finally discussed how a therapeutic strategy's trial should be designed to provide answer to this issue.
Collapse
|
92
|
Overcoming the challenges of primary tumor management in patients with metastatic colorectal cancer unresectable for cure and an asymptomatic primary tumor. Dis Colon Rectum 2014; 57:679-86. [PMID: 24807591 DOI: 10.1097/dcr.0000000000000025] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The management of asymptomatic primary tumor in patients with unresectable metastatic colorectal cancer remains inconsistent. OBJECTIVE This study aimed to determine the rate of symptom-directed surgery after systemic chemotherapy and to estimate the impact of initial primary tumor resection on survival in patients with unresectable metastatic colorectal cancer and an asymptomatic primary tumor. DESIGN This was a single-institution, retrospective observational study. SETTINGS The study was conducted in a tertiary referral hospital. PATIENTS Between 2005 and 2011, 191 consecutive patients with newly diagnosed stage IV colorectal cancer were identified. Of the 191, we analyzed 94 patients with unresectable, asymptomatic colorectal cancer. MAIN OUTCOME MEASURES We measured symptom-directed surgery and overall survival. RESULTS Forty-seven patients with an intact primary tumor received systemic chemotherapy (upfront chemotherapy group), 41 underwent primary tumor resection (upfront primary tumor resection group), and 6 underwent diversion enterostomy as first-line therapy. After excluding the 6 patients undergoing diversion enterostomy before systemic chemotherapy, this left 88 patients for final analysis. Twelve upfront chemotherapy patients required symptom-directed late surgery. Overall, 1-year and 2-year rates of symptom-directed surgery were 19.1% and 26.1%. In patients with nontraversable lesions by colonoscope at diagnosis, 64.3% required late intervention within 1 year. Competing risk regression analysis revealed that only colonoscopic traversability at diagnosis was significantly associated with symptom-directed late surgery (subhazard ratio, 7.9; p = 0.004). Median overall survival time was comparable between the 2 groups at 23.9 months for the upfront primary tumor resection group and 22.6 months for the upfront chemotherapy group (HR, 0.84; 95% CI: 0.51-1.39). LIMITATIONS This study was limited by its retrospective nature and small sample size. CONCLUSIONS Approximately 75% of upfront chemotherapy patients with unresectable, asymptomatic stage IV colorectal cancer can be spared initial resection of the primary tumor. Colonoscopic findings of nontraversable lesions at diagnosis may predict the need for late surgical intervention.
Collapse
|
93
|
Urethral metastasis from a sigmoid colon carcinoma: a quite rare case report and review of the literature. BMC Surg 2014; 14:31. [PMID: 24884559 PMCID: PMC4037280 DOI: 10.1186/1471-2482-14-31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/12/2014] [Indexed: 11/14/2022] Open
Abstract
Background Urethral metastatic adenocarcinoma is extremely rare. Moreover, only 9 previous cases with metastases from colorectal cancer have been reported to date, and not much information on urethral metastases from colorectum is available so far. Case presentation We report our experience in the diagnosis and the management of the case with urethral metastasis from a sigmoid colon cancer. A 68-year-old man, who underwent laparoscopic sigmoidectomy for sigmoid colon carcinoma four years ago, presented gross hematuria with pain. Urethroscopy identified a papillo-nodular tumor 7 mm in diameter in the bulbar urethra. CT-scan imaging revealed the small mass of bulbous portion of urethra and solitary lung metastasis. Histological examination of the tumor obtained by transurethral resection showed moderately differentiated adenocarcinoma, which was diagnosed as a metastasis of a sigmoid colon carcinoma pathologically by morphological examination. Immunohistochemical analysis of the urethral tumor revealed the positive for cytokertin 20 and CDX2, whereas negative for cytokertin 7. These features were consistent with metastatic adenocarcinoma of the sigmoid colon cancer. As the management of this case with urethral and lung metastasis, 6-cycle of chemotherapy with fluorouracil with leucovorin plus oxaliplatin was administered to the patient, and these metastases were disappeared with no recurrence of disease for 34 months. Conclusion Urethral metastasis from colorectal cancer is a very rare occurrence. However, in the presence of urinary symptoms, the possibility of the urethral metastasis should be considered.
Collapse
|
94
|
Prognostic significance of the preoperative serum C-reactive protein level in patients with stage IV colorectal cancer. Surg Today 2014; 45:315-21. [PMID: 24817059 DOI: 10.1007/s00595-014-0909-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/01/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE Previous studies have revealed that an elevated preoperative serum C-reactive protein (CRP) level is associated with a poor prognosis in patients with various malignant tumors. The aim of this study was to determine the clinical significance of the preoperative serum CRP level in patients with stage IV colorectal cancer. METHODS We enrolled 144 patients who underwent surgery for stage IV colorectal cancer. A total of 53 patients with a serum CRP level of ≥ 1.0 mg/dl were classified as the high CRP individuals. The association between the preoperative serum CRP level and survival was retrospectively assessed. RESULTS The cancer-specific survival of the patients with a high CRP level was significantly worse than that of the patients with a low CRP level. A multivariate analysis indicated that the curability (non-curative surgery), the number of organs with metastasis (more than one organ), the tumor diameter (≥ 5 cm), lymphatic involvement, histological differentiation (non-differentiated) and a high CRP level (≥ 1.0 mg/dl) were independent risk factors for a poor survival. CONCLUSIONS A high preoperative serum CRP level is a convenient biomarker for identifying patients with a poor prognosis for stage IV colorectal cancer.
Collapse
|
95
|
Van Loon K, Venook AP. Curable Patient With Metastatic Colorectal Cancer: Balancing Effective Therapies and Toxicities. J Clin Oncol 2014; 32:991-6. [DOI: 10.1200/jco.2013.53.5195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Alan P. Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| |
Collapse
|
96
|
Miyamoto Y, Watanabe M, Sakamoto Y, Shigaki H, Murata A, Sugihara H, Etoh K, Ishimoto T, Iwatsuki M, Baba Y, Iwagami S, Yoshida N, Baba H. Evaluation of the necessity of primary tumor resection for synchronous metastatic colorectal cancer. Surg Today 2014; 44:2287-92. [DOI: 10.1007/s00595-014-0869-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 12/16/2013] [Indexed: 12/21/2022]
|
97
|
Knab BR. Local management of the primary tumor in stage IV rectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
98
|
Tsang WY, Ziogas A, Lin BS, Seery TE, Karnes W, Stamos MJ, Zell JA. Role of primary tumor resection among chemotherapy-treated patients with synchronous stage IV colorectal cancer: a survival analysis. J Gastrointest Surg 2014; 18:592-8. [PMID: 24297651 PMCID: PMC4035039 DOI: 10.1007/s11605-013-2421-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 11/18/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The benefit of an operation to remove the primary tumor among patients with synchronous stage IV colorectal cancer is controversial. This study analyzed the survival benefits associated with primary tumor resection among chemotherapy-treated stage IV colorectal cancer patients. METHODS The study analyzed 11,716 chemotherapy-treated stage IV colorectal cancer patients in the California Cancer Registry between 1996 and 2007, with follow-up through 2009. Patients were stratified into operation and non-operation groups. Estimates of median overall and colorectal cancer-specific survival were generated. RESULTS Patients undergoing operation compared to those who are not had higher median overall and colorectal cancer-specific survival, 21 versus 10 months (p < 0.0001) and 22 versus 12 months (p < 0.0001), respectively. Patients who were offered surgery but refused had decreased median overall and colorectal cancer-specific survival when compared to patients who underwent resection, 8 versus 21 months (p < 0.001) and 7 versus 22 months (p < 0.001), respectively. In multivariate regression models, patients who underwent resection of primary tumor had improved overall (hazard ratio (HR), 0.42; 95% confidence interval (CI) 0.40-0.44, p < 0.0001) and colorectal cancer-specific survival (HR, 0.43; 95% CI, 0.41-0.45; p < 0.0001). CONCLUSION Primary tumor resection is associated with improved survival among stage IV chemotherapy-treated colorectal cancer patients.
Collapse
Affiliation(s)
- Walter Y Tsang
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA; Division of Hematology/Oncology, University of California, Irvine, CA 92697, USA; Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California, Irvine, CA 92697, USA
| | - Bruce S. Lin
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA; Division of Hematology/Oncology, University of California, Irvine, CA 92697, USA; Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Tara E. Seery
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA; Division of Hematology/Oncology, University of California, Irvine, CA 92697, USA; Department of Medicine, University of California, Irvine, CA 92697, USA
| | - William Karnes
- Division of Gastroenterology, University of California, Irvine, CA 92697, USA; Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Michael J. Stamos
- Department of Surgery, University of California, Irvine, CA 92697, USA
| | - Jason A. Zell
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA; Division of Hematology/Oncology, University of California, Irvine, CA 92697, USA; Department of Medicine, University of California, Irvine, CA 92697, USA; Department of Epidemiology, University of California, Irvine, CA 92697, USA
| |
Collapse
|
99
|
de Mestier L, Neuzillet C, Pozet A, Desot E, Deguelte-Lardière S, Volet J, Karoui M, Kianmanesh R, Bonnetain F, Bouché O. Is primary tumor resection associated with a longer survival in colon cancer and unresectable synchronous metastases? A 4-year multicentre experience. Eur J Surg Oncol 2014; 40:685-91. [PMID: 24630774 DOI: 10.1016/j.ejso.2014.02.236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the survival impact of primary tumor resection (PTR) in patients with metastatic colon cancer (mCC) and unresectable metastases. METHODS We retrospectively studied a multicenter cohort of consecutive mCC patients with unresectable metastases receiving first-line chemotherapy. A weighted Cox proportional regression model was used to balance for clinical variables associated with the probability of undergoing PTR, using inverse probability of treatment weighting (IPTW) based on a propensity score. RESULTS Ninety-six patients were included. PTR was performed in 69 (72%). The rates of secondary resection of metastases (p = 0.02) and bevacizumab administration (p = 0.02) were higher in the PTR group. Raw median overall survival (OS) was 23.1 months (95%CI[14.6-27.8]) in the PTR group and 22.1 months (95%CI[12.3-23.7]) in the non-PTR group (p = 0.11). After adjustment on IPTW, OS was 23.1 months (95%CI[17.0-28.7]) in the PTR group and 17.2 months (95%CI[13.5-22.2]) in the non-PTR group (HR 0.68; 95%CI[0.50-0.93]; p = 0.016). This result remained significant on multivariate analysis (HR 0.71; 95%CI[0.50-1.00]; p = 0.05). CONCLUSION In mCC patients with unresectable metastases receiving chemotherapy, up-front PTR was independently associated with prolonged OS. Patients eligible for secondary metastases resection and/or bevacizumab may benefit the most from PTR. Randomized controlled trials are mandatory.
Collapse
Affiliation(s)
- L de Mestier
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France.
| | - C Neuzillet
- Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Clichy, France
| | - A Pozet
- Unit of Methodology and Quality of Life in Oncology, EA 3181, Saint-Jacques University Hospital, Besançon, France
| | - E Desot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - S Deguelte-Lardière
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - J Volet
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - M Karoui
- Department of Digestive Surgery, Pitié-Salpetrière University Hospital, Assistance Publique Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
| | - R Kianmanesh
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - F Bonnetain
- Unit of Methodology and Quality of Life in Oncology, EA 3181, Saint-Jacques University Hospital, Besançon, France
| | - O Bouché
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France.
| |
Collapse
|
100
|
Lam VWT, Laurence JM, Pang T, Johnston E, Hollands MJ, Pleass HCC, Richardson AJ. A systematic review of a liver-first approach in patients with colorectal cancer and synchronous colorectal liver metastases. HPB (Oxford) 2014; 16:101-8. [PMID: 23509899 PMCID: PMC3921004 DOI: 10.1111/hpb.12083] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/26/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since the liver metastases rather than the colorectal cancer itself is the main determinant of patient's survival, the 'Liver-First Approach (LFA)' with upfront chemotherapy followed by a hepatic resection of colorectal liver metastases (CLM) and finally a colorectal cancer resection was proposed. The aim of this review was to analyse the evidence for LFA in patients with colorectal cancer and synchronous CLM. METHODS A literature search of databases (MEDLINE and EMBASE) to identify published studies of LFA in patients with colorectal cancer and synchronous CLM was undertaken focussing on the peri-operative regimens of LFA and survival outcomes. RESULTS Three observational studies and one retrospective cohort study were included for review. A total of 121 patients with colorectal cancer and synchronous CLM were selected for LFA. Pre-operative chemotherapy was used in 99% of patients. One hundred and twelve of the initial 121 patients (93%) underwent a hepatic resection of CLM. In total, 60% had a major liver resection and the R0 resection rate was 93%. Post-operative morbidity and mortality after the hepatic resection were 20% and 1%, respectively. Ultimately, 89 of the initial 121 (74%) patients underwent a colorectal cancer resection. Post-operative morbidity and mortality after a colorectal resection were 50% and 6%, respectively. The median overall survival was 40 months (range 19-50) with a recurrence rate of 52%. CONCLUSIONS Current evidence suggests that LFA is safe and feasible in selected patients with colorectal cancer and synchronous CLM. Future studies are required to further define patient selection criteria for LFA and the exact role of LFA in the management of synchronous CLM.
Collapse
Affiliation(s)
- Vincent WT Lam
- Department of Surgery Westmead Hospital, University of SydneySydney, NSW, Australia
- Discipline of Surgery, Sydney Medical SchoolSydney, NSW, Australia
| | - Jerome M Laurence
- Department of Surgery Westmead Hospital, University of SydneySydney, NSW, Australia
| | - Tony Pang
- Department of Surgery Westmead Hospital, University of SydneySydney, NSW, Australia
- Discipline of Surgery, Sydney Medical SchoolSydney, NSW, Australia
| | - Emma Johnston
- Department of Surgery Westmead Hospital, University of SydneySydney, NSW, Australia
- Discipline of Surgery, Sydney Medical SchoolSydney, NSW, Australia
| | - Michael J Hollands
- Department of Surgery Westmead Hospital, University of SydneySydney, NSW, Australia
- Discipline of Surgery, Sydney Medical SchoolSydney, NSW, Australia
| | - Henry CC Pleass
- Department of Surgery Westmead Hospital, University of SydneySydney, NSW, Australia
- Discipline of Surgery, Sydney Medical SchoolSydney, NSW, Australia
| | - Arthur J Richardson
- Department of Surgery Westmead Hospital, University of SydneySydney, NSW, Australia
- Discipline of Surgery, Sydney Medical SchoolSydney, NSW, Australia
| |
Collapse
|