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Bernardi L, Roesel R, Aghayan DL, Majno-Hurst PE, De Dosso S, Cristaudi A. Preoperative chemotherapy in upfront resectable colorectal liver metastases: New elements for an old dilemma? Cancer Treat Rev 2024; 124:102696. [PMID: 38335813 DOI: 10.1016/j.ctrv.2024.102696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
The use of preoperative or "neoadjuvant" chemotherapy (NAC) has long been controversial for resectable colorectal liver metastases (CRLM). The European Society of Medical Oncology (ESMO) 2023 guidelines on metastatic colorectal cancer (CRC) indicate a combination of surgical/technical and oncologic/prognostic criteria as the two determinants for allocating patients to NAC or upfront hepatectomy. However, surgical and technical criteria have evolved, and oncologic prognostic criteria date from the pre-modern chemotherapy era and lack prospective validation. The traditional literature is interpreted as not supporting the use of NAC because several studies fail to demonstrate a benefit in overall survival (OS) compared to upfront surgery; however, OS may not be the most appropriate endpoint to consider. Moreover, the commonly quoted studies against NAC contain many limitations that may explain why NAC failed to demonstrate its value. The query of the recent literature focused primarily on other aspects than OS, such as surgical technique, the impact of side effects of chemotherapy, the histological growth pattern of metastases, or the detection of circulating tumor DNA, shows data that support a more widespread use of NAC. These should prompt a critical reappraisal of the use of NAC, leading to a more precise selection of patients who could benefit from it.
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Affiliation(s)
- Lorenzo Bernardi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900 Lugano, Switzerland
| | - Raffaello Roesel
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900 Lugano, Switzerland
| | - Davit L Aghayan
- Department of Surgery, Ringerike Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Pietro E Majno-Hurst
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900 Lugano, Switzerland; Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Via Buffi 13, 6900 Lugano, Switzerland
| | - Sara De Dosso
- Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Via Buffi 13, 6900 Lugano, Switzerland; Medical Oncology Department, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Via A. Gallino 12, 6500 Bellinzona, Switzerland.
| | - Alessandra Cristaudi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900 Lugano, Switzerland; Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Via Buffi 13, 6900 Lugano, Switzerland
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Li Y, Gong J, Shen X, Li M, Zhang H, Feng F, Tong T. Assessment of Primary Colorectal Cancer CT Radiomics to Predict Metachronous Liver Metastasis. Front Oncol 2022; 12:861892. [PMID: 35296011 PMCID: PMC8919043 DOI: 10.3389/fonc.2022.861892] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 12/18/2022] Open
Abstract
ObjectivesTo establish and validate a machine learning-based CT radiomics model to predict metachronous liver metastasis (MLM) in patients with colorectal cancer.MethodsIn total, 323 patients were retrospectively recruited from two independent institutions to develop and evaluate the CT radiomics model. Then, 1288 radiomics features were extracted to decode the imaging phenotypes of colorectal cancer on CT images. The optimal radiomics features were selected using a recursive feature elimination selector configured by a support vector machine. To reduce the bias caused by an unbalanced dataset, the synthetic minority oversampling technique was applied to resample the minority samples in the datasets. Then, both radiomics and clinical features were used to train the multilayer perceptron classifier to develop two classification models. Finally, a score-level fusion model was developed to further improve the model performance.ResultsThe area under the curve (AUC) was 0.78 ± 0.07 for the tumour feature model and 0.79 ± 0.08 for the clinical feature model. The fusion model achieved the best performance, with AUCs of 0.79 ± 0.08 and 0.72 ± 0.07 in the internal and external validation cohorts.ConclusionsRadiomics models based on baseline colorectal contrast-enhanced CT have high potential for MLM prediction. The fusion model combining radiomics and clinical features can provide valuable biomarkers to identify patients with a high risk of colorectal liver metastases.
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Affiliation(s)
- Yue Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xigang Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Menglei Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
- *Correspondence: Feng Feng, ; Tong Tong,
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Feng Feng, ; Tong Tong,
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3
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Ratti F, Serenari M, Zanello M, Fuks D, Rottoli M, Masetti M, Tribillon E, Ravaioli M, Elmore U, Rosati R, Gayet B, Cescon M, Jovine E, Aldrighetti L. Team Strategy Optimization in Combined Resections for Synchronous Colorectal Liver Metastases. A Comparative Study with Bootstrapping Analysis. World J Surg 2021; 45:3424-3435. [PMID: 34313830 DOI: 10.1007/s00268-021-06260-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the study was to evaluate perioperative outcomes and to evaluate factors influencing rative morbidity and adoption of minimally invasive technique in 1-team (1-T) versus two teams (2-T) management of synchronous colorectal liver metastases. METHODS Within four referral centers, a group of 234 patients treated in 1-T centers was identified and compared with a group of 253 patients treated in 2-T. A nonparametric bootstrap process was applied to the original cohorts of 1-T group and 2-T group as a resampling method to obtain bootstrapped cohorts (155 patients per group). RESULTS 33.5% of patients in 1-T boot group and 38.1% in the 2-T boot group were operated by laparoscopic approach. Multivariate analysis revealed that approach to primary tumor (laparoscopic or open) and intraoperative blood loss were independent prognostic factors for morbidity. Team approach did not show any significant correlation with incidence of postoperative complications nor with choice for laparoscopic approach. CONCLUSION The optimization of team strategy for patients with SCRLM is not solely based on the adoption of a 1-T or 2-T approach, but should instead be based on the implementation of a standard protocol for management of these patients.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy.
| | - Matteo Serenari
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Zanello
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy
| | - David Fuks
- Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France
| | - Matteo Rottoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Surgery of the Alimentary Tract, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Michele Masetti
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy
| | - Ecoline Tribillon
- Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France
| | - Matteo Ravaioli
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ugo Elmore
- Division of Gastrointestinal Surgery, Azienda Ospedaliero-Universitaria di Bologna, San Raffaele Hospital, Milano, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, Azienda Ospedaliero-Universitaria di Bologna, San Raffaele Hospital, Milano, Italy
| | - Brice Gayet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France
| | - Matteo Cescon
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elio Jovine
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy
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Miyake H, Kawai K, Nozawa H, Sasaki K, Kaneko M, Murono K, Emoto S, Ishii H, Sonoda H, Ishihara S. Less intensive surveillance after radical surgery for stage I-III colorectal cancer by focusing on the doubling time of recurrence. Surg Today 2020; 51:550-560. [PMID: 32935208 DOI: 10.1007/s00595-020-02135-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To propose a new and improved surveillance schedule for colorectal cancer (CRC) patients by focusing on the recurrence rate, resectability, and especially, the tumor doubling time (DT) of recurrent tumors. METHODS The subjects of this retrospective review were 1774 consecutive patients who underwent radical surgery for stage I-III CRC between January, 2004 and December, 2015. We calculated the DT by measuring the tumor diameter using computed tomography (CT). RESULTS The median DT for recurrences in the liver, lung, peritoneum, and other locations were 35, 72, 85, and 36 days, respectively, (p < 0.001) and tumor growth rates differed according to the organs where recurrence developed. Multiple linear regression analysis showed that the DT was strongly associated with the relapse-free interval from primary surgery (p < 0.001), and that the DT in patients with recurrence detected ≥ 3 years after primary surgery was longer by 151.1 days than that in patients with recurrence detected within 1 year after primary surgery. We proposed a less intensive surveillance, which achieved an average cost reduction of 32.5% compared with conventional surveillance in Japan. CONCLUSION We propose a new and more cost-efficient surveillance schedule for CRC surgery patients in the clinical setting.
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Affiliation(s)
- Hiroaki Miyake
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Manabu Kaneko
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Ishii
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Foster JM, Patel A, Zhang C, Shostrom V, Brown K, Cushman-Vokoun AM. Investigating the utility of extended mutation analysis in gastrointestinal peritoneal metastasis. J Surg Oncol 2020; 122:1106-1113. [PMID: 32662065 DOI: 10.1002/jso.26114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Outcomes for gastrointestinal peritoneal metastases (GI-PM) are worse compared to systemic metastases, with a paucity of data exploring extended mutation profiling. An exploratory mutation analysis in GI-PMs was performed as a "proof of concept" of potential predictive values of profiling in GI-PM and rates of actionable mutations. METHODS The study included 40 GI-PM patients: 14 low-grade mucinous carcinoma peritonei and 26 HG-PM (12 colons, 10 appendix, 4 small bowels). Demographics, histologies, peritoneal cancer indexes, cytoreduction scores, and survival data were collected. NGS 50-gene mutation profiling was performed on 38 specimens. The association of mutations with survival was evaluated in high-grade PM. RESULTS KRAS, TP53, and SMAD4 mutations were observed in 61%, 29%, and 8% of cases across all tumor histologies. In 66% cases >1 mutations occurred, associated with decreased survival in HG-PM: 32 vs 73 months, P = .03. TP53 or SMAD4 mutations were associated with decreased survival in HG-PM: 22 vs 48 months, P = .02. Actionable mutations were detected in 70%. CONCLUSION Actionable mutations were detected at high rates. GI-PMs have similar mutational profiles and TP53, SMAD4, and/or >1 mutation were associate with decreased survival in HG-PM. This data supports the concept of the extended mutation profiling utility in GI-PM warranting further investigation.
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Affiliation(s)
- Jason M Foster
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Asish Patel
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Chunmeng Zhang
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Valerie Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Krista Brown
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska
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Kim YI, Park IJ, Kim JE, Kim SY, Park JH, Lee JH, Ha TY, Hong YS, Kim SY, Kim TW, Lim SB, Yu CS, Kim JC. Hepatic resection after neoadjuvant chemotherapy for patients with liver metastases from colorectal cancer: need for cautious planning. Ann Surg Treat Res 2019; 97:245-253. [PMID: 31742209 PMCID: PMC6848007 DOI: 10.4174/astr.2019.97.5.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/03/2019] [Accepted: 10/05/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Current neoadjuvant chemotherapy (NAC) may enable therapies such as surgical resection and local ablation of metastases in patients with colorectal liver metastasis (CLM). We evaluated outcomes in CLM patients who underwent resection and/or local treatment after NAC and identified prognostic factors for oncologic outcomes. Methods Patients who received NAC followed by resection and/or local treatment of hepatic metastasis from 2013 to 2015 were included. Treatment and tumor-related variables were tabulated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Cox regression analysis was used to identify factors associated with RFS and OS. Results Sixty-eight patients received NAC followed by resection and/or local treatment of hepatic metastases. Targeted therapy was administered in 50% of the patients. RFS was 35.8% at 1 year and 19.4% at 2 years postoperatively. OS was 95.6% at 1 year and 88.2% at 2 years postoperatively. In the multivariable analysis, R1 resection margin (hazard ratio [HR], 3.95; P = 0.008) of the liver metastases and ypN1/ypN2 (HR, 2.356 and 1.983, respectively; P = 0.041) were associated with poor RFS. Both factors were also significantly related to OS. Conclusion Resection margin of the metastatic tumor and ypN status are the only relevant factors for RFS and OS in CLM patients treated with NAC. Despite early and high rates of recurrence, CLM patients treated with NAC who undergo resection and/or local treatment have acceptable OS. Multidisciplinary review of candidates for surgery and cautious planning are crucial for achieving optimal outcomes.
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Affiliation(s)
- Young Il Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ratti F, Serenari M, Zanello M, Prosperi E, Cipriani F, Ercolani G, Jovine E, Cescon M, Aldrighetti L. Appraisal of disease-specific benefits of minimally invasiveness in surgery of breast cancer liver metastases. J Surg Oncol 2019; 120:1169-1176. [PMID: 31502270 DOI: 10.1002/jso.25702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The primary endpoint of this study is to analyze short term benefit of laparoscopic approach (minimally invasive liver surgery [MILS]) over the open techniques in patients submitted to surgery for breast cancer liver metastases (BCLM) within a disease-specific perspective. MATERIAL AND METHODS A group of 30 patients who underwent laparoscopic liver resection for BCLM constituted the Study group (MILS group) and was matched in a ratio of 1:2 with patients who underwent open surgery for BCLM (Open group, constituting the Control group). RESULTS MILS approach resulted in a statistically significant lower blood loss (150 vs 300 mL; P < .05). The rate of postoperative complications was similar (13.3% and 16.6% in the MILS and Open groups, respectively). MILS approach was associated with a shorter length of postoperative stay (4 ± 2 days) compared with the Open group (7 ± 3 days), allowing a faster return to adjuvant treatments. Both MILS and open groups showed adequate oncological radicality, with comparable long-term results. CONCLUSION MILS approach to BCLM represents the optimal instrument to obtain an adequate disease clearance in the selected group of patients candidates to surgery: the type of procedure (minor resections for limited hepatic disease) and characteristics of patients contribute to enhance the feasibility and the benefits of the laparoscopic technique.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Matteo Serenari
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Zanello
- Department of General Surgery, Maggiore Hospital, Bologna, Italy
| | - Enrico Prosperi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elio Jovine
- Department of General Surgery, Maggiore Hospital, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
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