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Michiel Zeeuw J, Wesdorp NJ, Ali M, Bakker AJJJ, Voigt KR, Starmans MPA, Roor J, Kemna R, van Waesberghe JHTM, van den Bergh JE, Nota IMGC, Moos SI, van Dieren S, van Amerongen MJ, Bond MJG, Chapelle T, van Dam RM, Engelbrecht MRW, Gerhards MF, van Gulik TM, Hermans JJ, de Jong KP, Klaase JM, Kok NFM, Leclercq WKG, Liem MSL, van Lienden KP, Quintus Molenaar I, Patijn GA, Rijken AM, Ruers TM, de Wilt JHW, Verpalen IM, Stoker J, Grunhagen DJ, Swijnenburg RJ, Punt CJA, Huiskens J, Verhoef C, Kazemier G. Prognostic value of total tumor volume in patients with colorectal liver metastases: A secondary analysis of the randomized CAIRO5 trial with external cohort validation. Eur J Cancer 2024; 207:114185. [PMID: 38924855 DOI: 10.1016/j.ejca.2024.114185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/30/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This study aimed to assess the prognostic value of total tumor volume (TTV) for early recurrence (within 6 months) and overall survival (OS) in patients with colorectal liver metastases (CRLM), treated with induction systemic therapy followed by complete local treatment. METHODS Patients with initially unresectable CRLM from the multicenter randomized phase 3 CAIRO5 trial (NCT02162563) who received induction systemic therapy followed by local treatment were included. Baseline TTV and change in TTV as response to systemic therapy were calculated using the CT scan before and the first after systemic treatment, and were assessed for their added prognostic value. The findings were validated in an external cohort of patients treated at a tertiary center. RESULTS In total, 215 CAIRO5 patients were included. Baseline TTV and absolute change in TTV were significantly associated with early recurrence (P = 0.005 and P = 0.040, respectively) and OS in multivariable analyses (P = 0.024 and P = 0.006, respectively), whereas RECIST1.1 was not prognostic for early recurrence (P = 0.88) and OS (P = 0.35). In the validation cohort (n = 85), baseline TTV and absolute change in TTV remained prognostic for early recurrence (P = 0.041 and P = 0.021, respectively) and OS in multivariable analyses (P < 0.0001 and P = 0.012, respectively), and showed added prognostic value over conventional clinicopathological variables (increase C-statistic, 0.06; 95 % CI, 0.02 to 0.14; P = 0.008). CONCLUSION Total tumor volume is strongly prognostic for early recurrence and OS in patients who underwent complete local treatment of initially unresectable CRLM, both in the CAIRO5 trial and the validation cohort. In contrast, RECIST1.1 did not show prognostic value for neither early recurrence nor OS.
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Affiliation(s)
- J Michiel Zeeuw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
| | - Nina J Wesdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Mahsoem Ali
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Anne-Joëlle J J Bakker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Kelly R Voigt
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martijn P A Starmans
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Pathology, Erasmus MC, Rotterdam, the Netherlands
| | - Joran Roor
- Department of Health, SAS Institute B.V., Huizen, the Netherlands
| | - Ruby Kemna
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Jan Hein T M van Waesberghe
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Janneke E van den Bergh
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Irene M G C Nota
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Shira I Moos
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Susan van Dieren
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | | | - Marinde J G Bond
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marc R W Engelbrecht
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | | | - Thomas M van Gulik
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - John J Hermans
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Koert P de Jong
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Joost M Klaase
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Niels F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Mike S L Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - Krijn P van Lienden
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - I Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St Antonius Hospital, Nieuwegein, the Netherlands
| | - Gijs A Patijn
- Department of Surgery, Isala Hospital, Zwolle, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Theo M Ruers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Inez M Verpalen
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Jaap Stoker
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Dirk J Grunhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Cornelis J A Punt
- Cancer Center Amsterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Joost Huiskens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Geert Kazemier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
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2
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Zhang Y, Yang Y, Qi X, Cui P, Kang Y, Liu H, Wei Z, Wang H. SLC14A1 and TGF-β signaling: a feedback loop driving EMT and colorectal cancer metachronous liver metastasis. J Exp Clin Cancer Res 2024; 43:208. [PMID: 39061061 PMCID: PMC11282742 DOI: 10.1186/s13046-024-03114-8] [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: 12/01/2023] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) metachronous liver metastasis is a significant clinical challenge, largely attributable to the late detection and the intricate molecular mechanisms that remain poorly understood. This study aims to elucidate the role of Solute Carrier Family 14 Member 1 (SLC14A1) in the pathogenesis and progression of CRC metachronous liver metastasis. METHODS We conducted a comprehensive analysis of CRC patient data from The Cancer Genome Atlas and GSE40967 databases, focusing on the differential expression of genes associated with non-metachronous liver metastasis and metachronous liver metastasis. Functional assays, both in vitro and in vivo, were performed to assess the biological impact of SLC14A1 modulation in CRC cells. Gene set enrichment analysis, molecular assays and immunohistochemical analyses on clinical specimens were employed to unravel the underlying mechanisms through which SLC14A1 exerts its effects. RESULTS SLC14A1 was identified as a differentially expressed gene, with its overexpression significantly correlating with poor relapse-free and overall survival. Mechanistically, elevated SLC14A1 levels enhanced CRC cell invasiveness and migratory abilities, corroborated by upregulated TGF-β/Smad signaling and Epithelial-Mesenchymal Transition. SLC14A1 interacted with TβRII and stabilized TβRII protein, impeding its Smurf1-mediated K48-linked ubiquitination and degradation, amplifying TGF-β/Smad signaling. Furthermore, TGF-β1 reciprocally elevated SLC14A1 mRNA expression, with Snail identified as a transcriptional regulator, binding downstream of SLC14A1's transcription start site, establishing a positive feedback loop. Clinically, SLC14A1, phosphorylated Smad2, and Snail were markedly upregulated in CRC patients with metachronous liver metastasis, underscoring their potential as prognostic markers. CONCLUSIONS Our findings unveil SLC14A1 as a critical regulator in CRC metachronous liver metastasis, providing novel insights into the molecular crosstalk between SLC14A1 and TGF-β/Smad signaling. These discoveries not only enhance our understanding of CRC metachronous liver metastasis pathogenesis, but also highlight SLC14A1 as a promising target for therapeutic intervention and predictive marker.
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Affiliation(s)
- Yixun Zhang
- Department of Colorectal Surgery, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Yumeng Yang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
- Laboratory for Clinical Medicine, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, China
| | - Xuan Qi
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
- Laboratory for Clinical Medicine, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, China
| | - Peng Cui
- Department of General Surgery, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi Kang
- Department of Gastroenterology, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Haiyi Liu
- Department of Colorectal Surgery, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Zhigang Wei
- Hepatobiliary and Pancreatic Surgery and Liver Transplantation Center, First Hospital of Shanxi Medical University, 85 Jiefang Nan Lu, Taiyuan, 030001, Shanxi, China.
| | - Haibo Wang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.
- Laboratory for Clinical Medicine, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, China.
- Beijing Laboratory of Oral Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, China.
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3
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Miller ED, Klamer BG, Cloyd JM, Pawlik TM, Williams TM, Hitchcock KE, Romesser PB, Mamon HJ, Ng K, Gholami S, Chang GJ, Anker CJ. Consideration of Metastasis-Directed Therapy for Patients With Metastatic Colorectal Cancer: Expert Survey and Systematic Review. Clin Colorectal Cancer 2024; 23:160-173. [PMID: 38365567 DOI: 10.1016/j.clcc.2024.01.004] [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: 11/21/2023] [Revised: 01/11/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND A survey of medical oncologists (MOs), radiation oncologists (ROs), and surgical oncologists (SOs) who are experts in the management of patients with metastatic colorectal cancer (mCRC) was conducted to identify factors used to consider metastasis-directed therapy (MDT). MATERIALS AND METHODS An online survey to assess clinical factors when weighing MDT in patients with mCRC was developed based on systematic review of the literature and integrated with clinical vignettes. Supporting evidence from the systematic review was included to aid in answering questions. RESULTS Among 75 experts on mCRC invited, 47 (response rate 62.7%) chose to participate including 16 MOs, 16 ROs, and 15 SOs. Most experts would not consider MDT in patients with 3 lesions in both the liver and lung regardless of distribution or timing of metastatic disease diagnosis (6 vs. 36 months after definitive treatment). Similarly, for patients with retroperitoneal lymph node and lung and liver involvement, most experts would not offer MDT regardless of timing of metastatic disease diagnosis. In general, SOs were willing to consider MDT in patients with more advanced disease, ROs were more willing to offer treatment regardless of metastatic site location, and MOs were the least likely to consider MDT. CONCLUSIONS Among experts caring for patients with mCRC, significant variation was noted among MOs, ROs, and SOs in the distribution and volume of metastatic disease for which MDT would be considered. This variability highlights differing opinions on management of these patients and underscores the need for well-designed prospective randomized trials to characterize the risks and potential benefits of MDT.
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Affiliation(s)
- Eric D Miller
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH.
| | - Brett G Klamer
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harvey J Mamon
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sepideh Gholami
- Department of Surgery, Division of Surgical Oncology, Northwell Health, New Hyde Park, NY
| | - George J Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher J Anker
- Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, VT
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4
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Milazzo M, Todeschini L, Caimano M, Mattia A, Cristin L, Martinino A, Bianco G, Spoletini G, Giovinazzo F. Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review. Cancers (Basel) 2024; 16:1849. [PMID: 38791928 PMCID: PMC11120322 DOI: 10.3390/cancers16101849] [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: 03/29/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Surgical resection is the gold standard for treating synchronous colorectal liver metastases (CRLM). The resection of the primary tumor and metastatic lesions can follow different sequences: "simultaneous", "bowel-first", and "liver-first". Conservative approaches, such as parenchymal-sparing surgery and segmentectomy, may serve as alternatives to major hepatectomy. A comprehensive search of Medline, Epistemonikos, Scopus, and the Cochrane Library was conducted. Studies evaluating patients who underwent surgery for CRLM and reported survival results were included. Other secondary outcomes were analyzed, including disease-free survival, perioperative complications and mortality, and recurrence rates. Quality assessment was performed using the AMSTAR-2 method. No significant differences in overall survival, disease-free survival, and secondary outcomes were observed when comparing simultaneous to "bowel-first" resections, despite a higher rate of perioperative mortality in the former group. The 5-year OS was significantly higher for simultaneous resection compared to "liver-first" resection. No significant differences in OS and DFS were noted when comparing "liver-first" to "bowel-first" resection, or anatomic to non-anatomic resection. Our umbrella review validates simultaneous surgery as an effective oncological approach for treating SCRLM, though the increased risk of perioperative morbidity highlights the importance of selecting suitable patients. Non-anatomic resections might be favored to preserve liver function and enable future surgical interventions.
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Affiliation(s)
- Martina Milazzo
- Department of Surgery, UpperGI Division Surgery, University of Verona, 37129 Verona, Italy
| | - Letizia Todeschini
- Faculty of Medicine and Surgery, University of Verona, 37129 Verona, Italy
| | - Miriam Caimano
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy
| | - Amelia Mattia
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy
| | - Luca Cristin
- Faculty of Medicine and Surgery, University of Verona, 37129 Verona, Italy
| | | | - Giuseppe Bianco
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy
| | - Gabriele Spoletini
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy
| | - Francesco Giovinazzo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy
- School of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
- Department of Surgery, Saint Camillus Hospital, 31100 Treviso, Italy
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5
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Chandra P, Sacks GD. Contemporary Surgical Management of Colorectal Liver Metastases. Cancers (Basel) 2024; 16:941. [PMID: 38473303 DOI: 10.3390/cancers16050941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20-30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.
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Affiliation(s)
- Pratik Chandra
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
- VA New York Harbor Healthcare System, New York, NY 10010, USA
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6
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Takei D, Kuroda S, Kobayashi T, Mashima H, Tahara H, Ohira M, Aikata H, Chosa K, Baba Y, Ohdan H. Prospective Exploratory Phase I Clinical Trial Assessing the Safety of Preoperative Marking for Small Liver Tumors. Cureus 2023; 15:e50603. [PMID: 38226110 PMCID: PMC10788183 DOI: 10.7759/cureus.50603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Background Small tumors in liver cirrhosis are difficult to distinguish using intraoperative ultrasonography. In addition, preoperative chemotherapy for metastatic liver cancer may diminish tumor size, thus making tumors difficult to identify intraoperatively. To address such difficulties, we devised a method to mark liver tumors preoperatively to facilitate intraoperative identification. This study aimed to investigate the safety of a preoperative liver tumor marking method. Methodology This exploratory prospective clinical trial included patients with liver tumors measuring ≤20 mm requiring resection. Preoperative marking was performed by placing a coil for embolization of blood vessels near the tumor using either the transcatheter or percutaneous approach. The tumor was identified and resected by intraoperative ultrasonography based on the marker. The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000028608). Results Overall, 19 patients (9 with primary liver cancer and 10 with metastatic tumors) were recruited. The transcatheter and percutaneous methods were used in 13 and 6 patients, respectively. Marking was not possible in two patients in the transcatheter group because the catheter could not be guided to the vicinity of the tumor. There were no marking-related complications. Hepatectomy was performed in all but one patient who was not fit for hepatectomy owing to the development of a metastatic liver tumor. The markers were adequately identified during hepatectomy. Additionally, there were no difficulties in the surgical procedure or postoperative complications. Conclusions Preoperative marking with embolization coils can be performed safely for intraoperative identification of liver nodules.
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Affiliation(s)
- Daisuke Takei
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiroaki Mashima
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, JPN
| | - Keigo Chosa
- Department of Diagnostic Radiology, Hiroshima University, Hiroshima, JPN
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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7
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Wesdorp NJ, Zeeuw JM, Postma SCJ, Roor J, van Waesberghe JHTM, van den Bergh JE, Nota IM, Moos S, Kemna R, Vadakkumpadan F, Ambrozic C, van Dieren S, van Amerongen MJ, Chapelle T, Engelbrecht MRW, Gerhards MF, Grunhagen D, van Gulik TM, Hermans JJ, de Jong KP, Klaase JM, Liem MSL, van Lienden KP, Molenaar IQ, Patijn GA, Rijken AM, Ruers TM, Verhoef C, de Wilt JHW, Marquering HA, Stoker J, Swijnenburg RJ, Punt CJA, Huiskens J, Kazemier G. Deep learning models for automatic tumor segmentation and total tumor volume assessment in patients with colorectal liver metastases. Eur Radiol Exp 2023; 7:75. [PMID: 38038829 PMCID: PMC10692044 DOI: 10.1186/s41747-023-00383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/08/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND We developed models for tumor segmentation to automate the assessment of total tumor volume (TTV) in patients with colorectal liver metastases (CRLM). METHODS In this prospective cohort study, pre- and post-systemic treatment computed tomography (CT) scans of 259 patients with initially unresectable CRLM of the CAIRO5 trial (NCT02162563) were included. In total, 595 CT scans comprising 8,959 CRLM were divided into training (73%), validation (6.5%), and test sets (21%). Deep learning models were trained with ground truth segmentations of the liver and CRLM. TTV was calculated based on the CRLM segmentations. An external validation cohort was included, comprising 72 preoperative CT scans of patients with 112 resectable CRLM. Image segmentation evaluation metrics and intraclass correlation coefficient (ICC) were calculated. RESULTS In the test set (122 CT scans), the autosegmentation models showed a global Dice similarity coefficient (DSC) of 0.96 (liver) and 0.86 (CRLM). The corresponding median per-case DSC was 0.96 (interquartile range [IQR] 0.95-0.96) and 0.80 (IQR 0.67-0.87). For tumor segmentation, the intersection-over-union, precision, and recall were 0.75, 0.89, and 0.84, respectively. An excellent agreement was observed between the reference and automatically computed TTV for the test set (ICC 0.98) and external validation cohort (ICC 0.98). In the external validation, the global DSC was 0.82 and the median per-case DSC was 0.60 (IQR 0.29-0.76) for tumor segmentation. CONCLUSIONS Deep learning autosegmentation models were able to segment the liver and CRLM automatically and accurately in patients with initially unresectable CRLM, enabling automatic TTV assessment in such patients. RELEVANCE STATEMENT Automatic segmentation enables the assessment of total tumor volume in patients with colorectal liver metastases, with a high potential of decreasing radiologist's workload and increasing accuracy and consistency. KEY POINTS • Tumor response evaluation is time-consuming, manually performed, and ignores total tumor volume. • Automatic models can accurately segment tumors in patients with colorectal liver metastases. • Total tumor volume can be accurately calculated based on automatic segmentations.
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Affiliation(s)
- Nina J Wesdorp
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - J Michiel Zeeuw
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Sam C J Postma
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Joran Roor
- Department of Health, SAS Institute B.V, Huizen, the Netherlands
| | - Jan Hein T M van Waesberghe
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Janneke E van den Bergh
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Irene M Nota
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Shira Moos
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruby Kemna
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Fijoy Vadakkumpadan
- Department of Computer Vision and Machine Learning, SAS Institute Inc, Cary, NC, USA
| | - Courtney Ambrozic
- Department of Computer Vision and Machine Learning, SAS Institute Inc, Cary, NC, USA
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | | | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Marc R W Engelbrecht
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Dirk Grunhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - John J Hermans
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Koert P de Jong
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joost M Klaase
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mike S L Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - Krijn P van Lienden
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - I Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Gijs A Patijn
- Department of Surgery, Isala Hospital, Zwolle, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Theo M Ruers
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost Huiskens
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
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8
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Fukuhara S, Kuroda S, Kobayashi T, Takei D, Namba Y, Oshita K, Matsubara K, Honmyo N, Nakano R, Sakai H, Tahara H, Ohira M, Kawaoka T, Tsuge M, Chosa K, Awai K, Ohdan H. Preoperative percutaneous or transvascular marking for curative resection of small liver tumours with potential for missing during hepatectomy: a study protocol for an open-label, single-arm phase II study. BMJ Open 2023; 13:e075891. [PMID: 37890974 PMCID: PMC10619086 DOI: 10.1136/bmjopen-2023-075891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Small liver tumours are difficult to identify during hepatectomy, which prevents curative tumour excision. Preoperative marking is a standard practice for small, deep-seated tumours in other solid organs; however, its effectiveness for liver tumours has not been validated. The objective of this study is to evaluate the effectiveness of preoperative markings for curative resection of small liver tumours. METHODS AND ANALYSIS This is an open-label, single-arm, single-centre, phase II study. Patients with liver tumours of ≤15 mm requiring hepatectomy will be enrolled and will undergo preoperative marking by placing a microcoil near the tumour using either the percutaneous or transvascular approach. The tumours, including the indwelling markers, will be excised. The primary endpoint will be the successful resection rate of liver tumours, defined as achieving a surgical margin of ≥5 mm and ≤15 mm. Secondary endpoints will include the results of preoperative marking and hepatectomy. ETHICS AND DISSEMINATION Ethical approval for this trial was obtained from the Ethical Committee for Clinical Research of Hiroshima University, Japan. The results will be published at an academic conference or by submitting a paper to a peer-reviewed journal. TRIAL REGISTRATION NUMBER jRCTs062220088.
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Affiliation(s)
- Sotaro Fukuhara
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Shintaro Kuroda
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Daisuke Takei
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yosuke Namba
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Ko Oshita
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Keiso Matsubara
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Naruhiko Honmyo
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Ryosuke Nakano
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Sakai
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Tahara
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Masahiro Ohira
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Tomokazu Kawaoka
- Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan
| | - Masataka Tsuge
- Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan
| | - Keigo Chosa
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
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9
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Jiang ZJ, Peng XD, Wei ZQ, Tang G. Effects of chronic liver disease on the outcomes of simultaneous resection of colorectal cancer with synchronous liver metastases: a propensity score matching study. Front Surg 2023; 10:1184887. [PMID: 37732162 PMCID: PMC10507906 DOI: 10.3389/fsurg.2023.1184887] [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: 03/12/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Given the rising prevalence of chronic liver disease (CLD), it is increasingly important to understand its impact on surgical outcomes. Our aim was to evaluate the impact of CLD on short-term outcomes in patients with colorectal cancer and synchronous liver metastases undergoing simultaneous surgery. Methods We retrospectively reviewed patients with colorectal cancer and liver metastases who underwent simultaneous resection between January 2013 and June 2022. Patients were divided into the CLD and non-CLD groups. Data regarding short-term surgical outcomes were compared between the two groups. Results A total of 187 patients were included. After propensity score matching, there were 42 patients in each group, and the basic characteristics of the two groups were similar. Patients with CLD had a significantly greater incidence of postoperative complications (47.6% vs. 26.2%; P = 0.042). The operation times of the CLD and non-CLD groups were similar (297 vs. 307.5 min, P = 0.537), and the blood loss was comparable between the two groups (250 vs. 155 ml, P = 0.066). No significant differences were observed between the two groups in pneumonia (P > 0.999), urinary infection rate (P > 0.999), ileus rate (P = 0.474), wound infection rates (P > 0.999), abdominal infection rate (P = 0.533), anastomotic leakage rate (P > 0.999), digestive hemorrhage rate (P > 0.999), bile leakage rate (P > 0.999), hepatic hemorrhage rate (P > 0.999), reoperation rate (P > 0.999), intensive care rate (P > 0.999), or severe liver failure (P > 0.999). There were no deaths in the two groups. CLD significantly prolonged the length of hospital stay (P = 0.011). Discussion CLD is an important factor affecting postoperative complications in patients with colorectal cancer liver metastases undergoing simultaneous surgery. Considering the large number of patients with CLD in China, more attention and medical care should be provided to patients with CLD who require simultaneous resection of colorectal cancer with synchronous liver metastases.
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Affiliation(s)
- Zheng-Jie Jiang
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Biliary Surgical Department of West China Hospital, Sichuan University, Chengdu, China
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10
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Papaconstantinou D, Pararas N, Pikouli A, Nastos C, Charalampopoulos A, Dellaportas D, Bagias G, Pikoulis E. Precision Surgery of Colorectal Liver Metastases in the Current Era: A Systematic Review. Cancers (Basel) 2023; 15:cancers15072083. [PMID: 37046744 PMCID: PMC10093504 DOI: 10.3390/cancers15072083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Liver resection for colorectal liver metastases (CRLM) is widely considered the treatment with the highest curative potential. However, not all patients derive the same oncological benefit, underlining the need for better patient stratification and treatment allocation. In this context, we performed a systematic review of the literature to determine the role of RAS status in selecting the optimal surgical strategy. Evidence comparing anatomical with non-anatomical resections depending on RAS mutational status was scarce and conflicting, with two studies reporting superiority in mutated RAS (mutRAS) patients and two studies reporting equivalent outcomes. The rate of incomplete microscopic resection (R1) was found to be increased among mutRAS patients, possibly due to higher micrometastatic spread lateral to the primary lesion. The impact of R1 resection margins was evaluated separately for mutRAS and wild-type patients in three studies, of which, two indicated an additive detriment to long-term survival in the former group. In the current era of precision surgery, RAS status can be utilized to predict the efficacy of liver resection in the treatment of CRLM, avoiding a potentially morbid operation in patients with adverse tumor profiles.
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11
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Chen FL, Wang YY, Liu W, Xing BC. Neoadjuvant chemotherapy improves overall survival in resectable colorectal liver metastases patients with high clinical risk scores—— A retrospective, propensity score matching analysis. Front Oncol 2022; 12:973418. [PMID: 36132151 PMCID: PMC9483158 DOI: 10.3389/fonc.2022.973418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background The use of neoadjuvant chemotherapy (NAC) in resectable colorectal liver metastases (CRLM) patients is controversial. High-risk patients are more likely to benefit from NAC despite its hepatotoxic effects. Since patients with a high tumor burden receive NAC more frequently, previous retrospective studies have imbalanced baseline characteristics. The results of randomized controlled trials are still pending. This study aimed to assess the efficacy of NAC in resectable CRLM patients with high clinical risk scores (CRS) proposed by Fong et al. after balancing baseline characteristics by propensity score matching (PSM). Methods Resectable CRLM patients with high CRS (3-5) undergoing hepatectomy between January 2003 and May 2021 were retrospectively studied. Patients were divided into the NAC and the upfront surgery group. Survival outcomes and surgical outcomes were compared after PSM. Results The current study included 322 patients with a median follow-up of 40 months. After one-to-two PSM, patients were matched into the upfront surgery group (n = 56) and the NAC group (n = 112). Baseline characteristics were balanced after matching. There was no difference in long-term progression-free survival (PFS), while overall survival (OS) from the initial diagnosis was improved in the NAC group (P = 0.048). Postoperative hospital stays were shorter in the NAC group (P = 0.020). Surgical outcomes were similar, including major hepatectomy rate, intraoperative ablation rate, blood loss, operative time, perioperative blood transfusion, positive surgical margin, and postoperative intensive care unit stay. In multivariable analysis, RAS mutation, maximum tumor diameter≥3cm, and no NAC were independent risk factors for OS. The 1-year PFS in the NAC group was improved, although it failed to reach a statistical difference (P = 0.064). Conclusions NAC could improve OS in resectable CRLM patients with high CRS (3-5) and have a shorter postoperative hospital stay.
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12
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Shi Q, Wang F, Du N, Zhou Y, Zhou X, Ma J, Yang M, Zhang Z, Yu J, Zhang W, Luo J, Liu L, Yan Z. Microwave ablation combined with lipiodol-microsphere mixed or conventional transarterial chemoembolization for the treatment of colorectal liver metastases: A retrospective study. Clin Res Hepatol Gastroenterol 2022; 46:101986. [PMID: 35772684 DOI: 10.1016/j.clinre.2022.101986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/19/2022] [Accepted: 06/26/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the clinical outcomes of microwave ablation (MWA) combined with lipiodol-microsphere mixed transarterial chemoembolization (mTACE) or conventional TACE (cTACE) for patients with colorectal liver metastases (CRLM). MATERIALS AND METHODS This retrospective study evaluated the medical records of patients with CRLM who underwent MWA combined with mTACE or cTACE from January 2018 to September 2021. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were evaluated during the follow-up. In addition, prognostic factors affecting survival were analyzed by univariate and multivariate methods. RESULTS A total of 79 patients with CRLM were enrolled in the study (MWA-mTACE group, n = 38; MWA-cTACE group, n = 41). The patients who underwent MWA-mTACE had higher DCR (86.8% vs. 65.9%, P = 0.029) and better PFS (median, 8.1 vs. 5.5 months, P = 0.018) than those who underwent MWA-cTACE, but no significant difference was found in ORR (34.2% vs. 22.0%, P = 0.225) and OS (median, 15.7 vs. 13.0 months, P = 0.231). Further univariate and multivariate analyses indicated that MWA-mTACE was an independent positive factor for PFS, and abnormal carcinoembryonic antigen level was a hazard factor for OS. The postoperative laboratory tests and complications in patients who underwent MWA-mTACE were similar to those who underwent MWA-cTACE. CONCLUSION Lipiodol-microsphere mixed TACE might be an effective and safe treatment to combine with microwave ablation for patients with colorectal liver metastases.
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Affiliation(s)
- Qin Shi
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Feihang Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Nan Du
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yongjie Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jiaze Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institution of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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13
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Impact of anatomical liver resection on patient survival in KRAS-wild-type colorectal liver metastasis: A multicenter retrospective study. Surgery 2022; 172:1133-1140. [PMID: 35965146 DOI: 10.1016/j.surg.2022.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Liver resection is a standard therapy for colorectal liver metastasis. However, the impact of anatomical resection and nonanatomical resection on the survival in patients with Kirsten rat sarcoma-wild-type and Kirsten rat sarcoma-mutated colorectal liver metastasis remain unclear. We investigated whether anatomical resection versus nonanatomical resection improves survival in colorectal liver metastasis stratified by Kirsten rat sarcoma mutational status. METHODS Among 639 consecutive patients with colorectal liver metastasis who underwent primary liver resection between January 2008 and December 2017, 349 patients were excluded due to their unknown Kirsten rat sarcoma mutational status, or due to receiving anatomical resection with concomitant non-anatomical resection, radiofrequency, or R2 resection. Accordingly, 290 patients with colorectal liver metastasis were retrospectively assessed. The relationships between resection types and survival were investigated in Kirsten rat sarcoma-wild-type and -mutated groups. RESULTS Anatomical resection was performed in 77/186 (41%) and 44/104 (42%) patients with Kirsten rat sarcoma-wild-type and Kirsten rat sarcoma-mutated genetic statuses, respectively. For both, the clinical-pathologic factors were comparable, except a larger maximum tumor size and surgical margin were observed in anatomical resection cases. Anatomical resection patients had significantly longer recurrence-free survival and overall survival than nonanatomical resection cases in the Kirsten rat sarcoma-wild-type group (recurrence-free survival, P < .001; overall survival, P = .005). No significant recurrence-free survival or overall survival differences were observed between Kirsten rat sarcoma-mutated anatomical resection and non-anatomical resection (recurrence-free survival, P = .132; overall survival, P = .563). Although, intrahepatic recurrence in Kirsten rat sarcoma-wild-type and -mutated colorectal liver metastasis was comparable (P = .973), extrahepatic recurrence was increased in Kirsten rat sarcoma-mutated versus -wild-type colorectal liver metastasis (P < .001). CONCLUSION In contrast to Kirsten rat sarcoma-mutated colorectal liver metastasis with higher extrahepatic recurrence after liver resection, local liver control via anatomical resection improved the postoperative survival in patients with Kirsten rat sarcoma-wild-type colorectal liver metastasis.
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Ghamarnejad O, Stavrou GA. Parenchymsparende Operationen oder anatomische Resektionen bei
Lebermetastasen des kolorektalen Karzinoms? Zentralbl Chir 2022; 147:381-388. [DOI: 10.1055/a-1844-0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ZusammenfassungDarmkrebs ist eine der häufigsten Todesursachen in der westlichen Welt. Die
Hälfte der Patienten entwickelt kolorektale Lebermetastasen (CRLM), dabei weisen
weniger als 30% der Patienten zum Zeitpunkt der Diagnose eine chirurgisch
resektable Metastasierung auf. Im Falle einer Resektabilität bietet die
klassische anatomische (Major-)Hepatektomie eine hohe R0-Resektionsrate,
allerdings bei gleichzeitig erhöhter Morbidität und Mortalität. In den letzten 2
Jahrzehnten wurden die potenziellen Vorteile der parenchymsparenden Hepatektomie
(PSH) in Bezug auf die onkologischen Gesamtergebnisse, das Überleben und die
Re-Resektion im Falle eines Rezidivs („Salvageability“) nachgewiesen. Der
Beitrag fasst die aktuellen Erkenntnisse zur PSH als chirurgische Therapieoption
zusammen und diskutiert den aktuellen „state of the art“ in verschiedenen
Szenarien.
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Affiliation(s)
- Omid Ghamarnejad
- Allgemein-, Viszeral und Thoraxchirurgie, Chirurgische
Onkologie, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland
| | - Gregor Alexander Stavrou
- Allgemein- Vszeral und Thoraxchirurgie, Chirurgische
Onkologie, Klinikum Saarbrücken gGmbH, Saarbrücken, Deutschland
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15
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Takeda K, Sawada Y, Yabushita Y, Honma Y, Kumamoto T, Watanabe J, Matsuyama R, Kunisaki C, Misumi T, Endo I. Efficacy of neoadjuvant chemotherapy for initially resectable colorectal liver metastases: A retrospective cohort study. World J Gastrointest Oncol 2022; 14:1281-1294. [PMID: 36051104 PMCID: PMC9305572 DOI: 10.4251/wjgo.v14.i7.1281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/29/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The liver is the most common metastatic site of colorectal cancer. Hepatectomy is the mainstay of treatment for patients with colorectal liver metastases (CRLMs). However, there are cases of early recurrence after upfront hepatectomy alone. In selected high-risk patients, neoadjuvant chemotherapy (NAC) may improve long-term survival.
AIM To determine the efficacy of NAC for initially resectable CRLMs.
METHODS Among 644 patients who underwent their first hepatectomy for CRLMs at our institution, 297 resectable cases were stratified into an upfront hepatectomy group (238 patients) and a NAC group (59 patients). Poor prognostic factors for upfront hepatectomy were identified using multivariate logistic regression analysis. Propensity score matching was used to compare clinical outcomes between the upfront hepatectomy and NAC groups, according to the number of poor prognostic factors. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test.
RESULTS Preoperative carcinoembryonic antigen levels (≥ 10 ng/mL) (P = 0.003), primary histological type (other than well/moderately differentiated) (P = 0.04), and primary lymph node metastases (≥ 1) (P = 0.04) were identified as independent poor prognostic factors for overall survival (OS) in the upfront hepatectomy group. High-risk status was defined as the presence of two or more risk factors. After propensity score matching, 50 patients were matched in each group. Among high-risk patients, the 5-year OS rate was significantly higher in the NAC group (13 patients) than in the upfront hepatectomy group (18 patients) (100% vs 34%; P = 0.02).
CONCLUSION NAC may improve the prognosis of high-risk patients with resectable CRLMs who have two or more risk factors.
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Affiliation(s)
- Kazuhisa Takeda
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yu Sawada
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yasuhiro Yabushita
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Jordan
| | - Yuki Honma
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Jordan
| | - Takafumi Kumamoto
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Jordan
| | - Jun Watanabe
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Jordan
| | - Chikara Kunisaki
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Jordan
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16
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Meijer TS, Dieters JHN, de Leede EM, de Geus-Oei LF, Vuijk J, Martini CH, van Erkel AR, Lutjeboer J, van der Meer RW, Tijl FGJ, Kapiteijn E, Vahrmeijer AL, Burgmans MC. Prospective evaluation of percutaneous hepatic perfusion with melphalan as a treatment for unresectable liver metastases from colorectal cancer. PLoS One 2022; 17:e0261939. [PMID: 35025911 PMCID: PMC8758076 DOI: 10.1371/journal.pone.0261939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Percutaneous hepatic perfusion with melphalan (M-PHP) is increasingly used in patients with liver metastases from various primary tumors, yet data on colorectal liver metastases (CRLM) are limited. The aim of this study was to prospectively evaluate the efficacy and safety of M-PHP in patients with CRLM. Materials and methods Prospective, single-center, single-arm phase II study of M-PHP with hemofiltration in patients with unresectable CRLM. Proven, extrahepatic metastatic disease was one of the exclusion criteria. Primary outcomes were overall response rate (ORR) and best overall response (BOR). Secondary outcomes were overall survival (OS), progression-free survival (PFS), hepatic PFS (hPFS), and safety. Results A total of 14 M-PHP procedures were performed in eight patients between March 2014 and December 2015. All patients (median age 56 years, ranging from 46 to 68) had received (extensive) systemic chemotherapy before entering the study. The ORR was 25.0%, with two out of eight patients showing partial response as BOR. Median OS was 17.3 months (ranging from 2.6 to 30.9) with a one-year OS of 50.0%. Median PFS and hPFS were 4.4 and 4.5 months, respectively. No serious adverse events occurred. Grade 3/4 hematologic adverse events were observed in the majority of patients, though all were transient and well-manageable. Conclusion M-PHP is a safe procedure with only limited efficacy in patients with unresectable CRLM who already showed progression of disease after receiving one or more systemic treatment regimens.
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Affiliation(s)
- T. Susanna Meijer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | - Jan H. N. Dieters
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora M. de Leede
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Jaap Vuijk
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian H. Martini
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arian R. van Erkel
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Lutjeboer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Fred G. J. Tijl
- Department of Extra Corporal Circulation, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Mark C. Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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17
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van de Geest T, van Amerongen M, Nierop P, Höppener D, Grünhagen D, Moelker A, Fütterer J, Verhoef C, de Wilt J. Propensity score matching demonstrates similar results for radiofrequency ablation compared to surgical resection in colorectal liver metastases. Eur J Surg Oncol 2022; 48:1368-1374. [DOI: 10.1016/j.ejso.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
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18
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Wesdorp NJ, Bolhuis K, Roor J, van Waesberghe JHTM, van Dieren S, van Amerongen MJ, Chapelle T, Dejong CHC, Engelbrecht MRW, Gerhards MF, Grunhagen D, van Gulik TM, Hermans JJ, de Jong KP, Klaase JM, Liem MSL, van Lienden KP, Molenaar IQ, Patijn GA, Rijken AM, Ruers TM, Verhoef C, de Wilt JHW, Swijnenburg RJ, Punt CJA, Huiskens J, Kazemier G. The Prognostic Value of Total Tumor Volume Response Compared With RECIST1.1 in Patients With Initially Unresectable Colorectal Liver Metastases Undergoing Systemic Treatment. ANNALS OF SURGERY OPEN 2021; 2:e103. [PMID: 37637880 PMCID: PMC10455281 DOI: 10.1097/as9.0000000000000103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/17/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives Compare total tumor volume (TTV) response after systemic treatment to Response Evaluation Criteria in Solid Tumors (RECIST1.1) and assess the prognostic value of TTV change and RECIST1.1 for recurrence-free survival (RFS) in patients with colorectal liver-only metastases (CRLM). Background RECIST1.1 provides unidimensional criteria to evaluate tumor response to systemic therapy. Those criteria are accepted worldwide but are limited by interobserver variability and ignore potentially valuable information about TTV. Methods Patients with initially unresectable CRLM receiving systemic treatment from the randomized, controlled CAIRO5 trial (NCT02162563) were included. TTV response was assessed using software specifically developed together with SAS analytics. Baseline and follow-up computed tomography (CT) scans were used to calculate RECIST1.1 and TTV response to systemic therapy. Different thresholds (10%, 20%, 40%) were used to define response of TTV as no standard currently exists. RFS was assessed in a subgroup of patients with secondarily resectable CRLM after induction treatment. Results A total of 420 CT scans comprising 7820 CRLM in 210 patients were evaluated. In 30% to 50% (depending on chosen TTV threshold) of patients, discordance was observed between RECIST1.1 and TTV change. A TTV decrease of >40% was observed in 47 (22%) patients who had stable disease according to RECIST1.1. In 118 patients with secondarily resectable CRLM, RFS was shorter for patients with less than 10% TTV decrease compared with patients with more than 10% TTV decrease (P = 0.015), while RECIST1.1 was not prognostic (P = 0.821). Conclusions TTV response assessment shows prognostic potential in the evaluation of systemic therapy response in patients with CRLM.
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Affiliation(s)
- Nina J. Wesdorp
- From the Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karen Bolhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joran Roor
- Department of Health, SAS Institute B.V., Huizen, The Netherlands
| | - Jan-Hein T. M. van Waesberghe
- Department of Radiology and Molecular Imaging, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin J. van Amerongen
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Cornelis H. C. Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Marc R. W. Engelbrecht
- Department of Radiology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael F. Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
| | - Dirk Grunhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Thomas M. van Gulik
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - John J. Hermans
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Koert P. de Jong
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost M. Klaase
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mike S. L. Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Krijn P. van Lienden
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - I. Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gijs A. Patijn
- Department of Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Arjen M. Rijken
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Theo M. Ruers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Johannes H. W. de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J. A. Punt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost Huiskens
- Department of Health, SAS Institute B.V., Huizen, The Netherlands
| | - Geert Kazemier
- From the Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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19
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Czauderna C, Luley K, von Bubnoff N, Marquardt JU. Tailored Systemic Therapy for Colorectal Cancer Liver Metastases. Int J Mol Sci 2021; 22:11780. [PMID: 34769209 PMCID: PMC8584068 DOI: 10.3390/ijms222111780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
Liver metastases are the most common site of metastatic spread in colorectal cancer. Current treatment approaches involve effective systemic therapies in combination with surgical and/or interventional strategies. Multimodal strategies greatly improved clinical outcomes of patients with metastatic colorectal cancer over the last decades. Identification of predictive and prognostic biomarkers helped to comprehensively refine individual targeted treatment approaches and resulted in median overall survival rates of 30 months or longer. Current guidelines, thus, recommend treatment selection according to patients' performance status, tumor localization and stage as well as the tumor's molecular and genetic status. Here, we outline the latest developments in molecular decision-making for patients with upfront resectable, potentially or initially unresectable and non/never-resectable colorectal cancer liver metastases.
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Affiliation(s)
- Carolin Czauderna
- Department of Medicine I, University Medical Center Schleswig-Holstein—Campus Lübeck, 23558 Lübeck, Germany;
| | - Kim Luley
- Department of Hemato-Oncology, University Medical Center Schleswig-Holstein—Campus Lübeck, 23558 Lübeck, Germany; (K.L.); (N.v.B.)
| | - Nikolas von Bubnoff
- Department of Hemato-Oncology, University Medical Center Schleswig-Holstein—Campus Lübeck, 23558 Lübeck, Germany; (K.L.); (N.v.B.)
| | - Jens U. Marquardt
- Department of Medicine I, University Medical Center Schleswig-Holstein—Campus Lübeck, 23558 Lübeck, Germany;
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20
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Lee HY, Woo IS. Perioperative Systemic Chemotherapy for Colorectal Liver Metastasis: Recent Updates. Cancers (Basel) 2021; 13:cancers13184590. [PMID: 34572817 PMCID: PMC8464667 DOI: 10.3390/cancers13184590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary The development of cytotoxic chemotherapy, targeted agents and immune check point inhibitors has improved survival outcomes and quality of life in patients diagnosed with metastatic colorectal cancer (CRC). Long-term survival and cure are possible in well-selected CRC patients with liver metastases (LM). The criteria for resectable LM and the eligibility of patients should be evaluated at the time of diagnosis or during the clinical course via a multidisciplinary team approach. The advantages of adjuvant chemotherapy after curative resection of LM are uncertain currently. Systemic preoperative chemotherapy may convert unresectable LM to a resectable type. However, the optimal combination of systemic drugs and treatment strategy has yet to be established. This article summarizes recent reports of perioperative systemic treatment for patients with colorectal liver metastases (CLM). This review provides an update for physicians involved in managing patients with CLM. Abstract The liver is the most common site of metastases for colorectal cancer. Complete resection in some patients with resectable liver metastases (LM) can lead to long-term survival and cure. Adjuvant systemic chemotherapy after complete resection of LM improves recurrence-free survival; however, the overall survival benefit is not clear. In selected patients, preoperative systemic treatment for metastatic colorectal cancer can convert unresectable to resectable cancer. This review will focus on patient selection, and integration of perioperative and postoperative systemic treatment to surgery in resectable and initially unresectable LM. Additionally, new drugs and biomarkers will be discussed.
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21
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Wu Y, Guo T, Xu Z, Liu F, Cai S, Wang L, Xu Y. Risk scoring system for recurrence after simultaneous resection of colorectal cancer liver metastasis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:966. [PMID: 34277766 PMCID: PMC8267263 DOI: 10.21037/atm-21-2595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/11/2021] [Indexed: 12/30/2022]
Abstract
Background The simultaneous resection of synchronous colorectal cancer liver metastasis (SCRLM) has been widely applied. It is necessary to establish a risk scoring system to predict post-operative recurrence, especially in patients with neoadjuvant treatment. Methods The medical records of 221 patients undergoing simultaneous resection of CRLM were assessed in this study with a further 128 patients allocated to a validation group. All patients in the study group were classified according to their history of neoadjuvant treatment and univariate and multivariate analyses were applied to study independent risk factors. A score model was then generated according to the factors included. Our data set were also applied to validate three other existing scoring models [Fong clinical recurrence score (CRS), Konopke, and Zakaria disease-free survival (DFS) score], and the concordance index was calculated for comparison among these models. Results CRLM involving more than three nodes positive for a primary tumor was considered an independent risk factor for progression in patients without neoadjuvant treatment and all score models could discretely stratify patients according to disease free survival. In patients receiving neoadjuvant treatment, CRLM involving more than one node and transfusion invasion were major determinants in patients after treatment. However, only our scoring system and Fong’s CRS score could discretely discriminate patients. In the validation group, patients were significantly classified with the score system. Conclusions Existing score models had better values for determining prognosis in patients with SCRLM, especially in those undertaking neoadjuvant treatment. Larger cohorts, along with more detailed clinical features and multicenter validation should be undertaken before utilization.
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Affiliation(s)
- Yuchen Wu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tianan Guo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhenhong Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lu Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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22
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Wesdorp NJ, van Goor VJ, Kemna R, Jansma EP, van Waesberghe JHTM, Swijnenburg RJ, Punt CJA, Huiskens J, Kazemier G. Advanced image analytics predicting clinical outcomes in patients with colorectal liver metastases: A systematic review of the literature. Surg Oncol 2021; 38:101578. [PMID: 33866191 DOI: 10.1016/j.suronc.2021.101578] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND To better select patients with colorectal liver metastases (CRLM) for an optimal selection of treatment strategy (i.e. local, systemic or combined treatment) new prognostic models are warranted. In the last decade, radiomics has emerged as a field to create predictive models based on imaging features. This systematic review aims to investigate the current state and potential of radiomics to predict clinical outcomes in patients with CRLM. METHODS A comprehensive literature search was conducted in the electronic databases of PubMed, Embase, and Cochrane Library, according to PRISMA guidelines. Original studies reporting on radiomics predicting clinical outcome in patients diagnosed with CRLM were included. Clinical outcomes were defined as response to systemic treatment, recurrence of disease, and survival (overall, progression-free, disease-free). Primary outcome was the predictive performance of radiomics. A narrative synthesis of the results was made. Methodological quality was assessed using the radiomics quality score. RESULTS In 11 out of 14 included studies, radiomics was predictive for response to treatment, recurrence of disease, survival, or a combination of outcomes. Combining clinical parameters and radiomic features in multivariate modelling often improved the predictive performance. Different types of individual features were found prognostic. Noticeable were the contrary levels of heterogeneous and homogeneous features in patients with good response. The methodological quality as assessed by the radiomics quality score varied considerably between studies. CONCLUSION Radiomics appears a promising non-invasive method to predict clinical outcome and improve personalized decision-making in patients with CRLM. However, results were contradictory and difficult to compare. Standardized prospective studies are warranted to establish the added value of radiomics in patients with CRLM.
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Affiliation(s)
- N J Wesdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.
| | - V J van Goor
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - R Kemna
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - E P Jansma
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology and Biostatistics, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - J H T M van Waesberghe
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Molecular Imaging, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - R J Swijnenburg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - C J A Punt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Department of Epidemiology, Utrecht, the Netherlands
| | - J Huiskens
- SAS Institute B.V., Flevolaan 69, Huizen, the Netherlands
| | - G Kazemier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
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23
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Bolhuis K, Kos M, van Oijen MGH, Swijnenburg RJ, Punt CJA. Conversion strategies with chemotherapy plus targeted agents for colorectal cancer liver-only metastases: A systematic review. Eur J Cancer 2020; 141:225-238. [PMID: 33189037 DOI: 10.1016/j.ejca.2020.09.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is no consensus on the optimal systemic conversion therapy in patients with unresectable colorectal cancer liver-only metastases (CRLM) to achieve a complete resection. Interpretation of trials is complicated by heterogeneity of patients caused by emerging prognostic and predictive characteristics, such as RAS/BRAF mutation status, lack of consensus on unresectability criteria and lack of data on clinical outcome of secondary resections. A systematic review was performed of characteristics of study populations and methodology of trials regarding patients with initially unresectable colorectal cancer liver-only metastases. METHODS Phase II/III randomised trials, published after 2008, regarding first-line systemic conversion therapy in patients or subgroups of patients with CRLM were included. Data on secondary resection outcomes were collected. RESULTS Overall, 20 trials were included for analysis: seven prospective trials in patients with unresectable CRLM and 13 trials in the overall population of unresectable metastatic colorectal cancer (mCRC) with retrospective subgroup analysis of CRLM patients. Fourteen trials did not provide unresectability criteria at baseline, and criteria differed among the remaining studies. Trials and study populations were heterogeneous in prognostic/predictive factors, use of primary end-points, and reporting on long-term clinical outcomes. R0-resection rates in CRLM patients varied between CRLM studies and mCRC studies, with rates of 22-57% and 11-38%, respectively. CONCLUSIONS Cross-study comparison of (subgroups of) studies regarding first-line systemic treatment in patients with unresectable CRLM is hampered by heterogeneity in study populations, trial designs, use of (K)RAS/BRAF mutational tumour status, and differences/absence of unresectability criteria. No optimal conversion systemic regimen can be selected from available data. Prospective studies with well-defined criteria of these issues are warranted.
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Affiliation(s)
- Karen Bolhuis
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands.
| | - Milan Kos
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Martijn G H van Oijen
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Cornelis J A Punt
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
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24
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Hellingman T, de Swart ME, Joosten JJA, Meijerink MR, de Vries JJJ, de Waard JWD, van Zweeden AA, Zonderhuis BM, Kazemier G. The value of a dedicated multidisciplinary expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases. Surg Oncol 2020; 35:412-417. [PMID: 33035790 DOI: 10.1016/j.suronc.2020.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/18/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND For patients with colorectal cancer liver metastases (CRLM), local treatment is the only treatment with curative intent. The majority of patients with CRLM are however evaluated in multidisciplinary teams of colorectal cancer specialists often lacking expertise in local treatment of liver tumors. The aim of this study was therefore to assess the value of a dedicated multidisciplinary panel consisting of hepatobiliary surgeons and interventional radiologists for patients suffering from liver-only CRLM. METHODS Patients diagnosed with liver-only CRLM in 2016 were identified in a tertiary referral hospital, and two of the referring hospitals in the Netherlands. Diagnostic imaging was independently reviewed by a panel of four hepatobiliary surgeons and two interventional radiologists to re-evaluate treatment strategy retrospectively. If two or more panelists assessed all lesions eligible for resection and/or ablation, patients were deemed eligible for local treatment with curative intent. Interrater reliability between hepatobiliary surgeons was assessed through intraclass correlation coefficient (ICC) and weighted Cohen's kappa. RESULTS Diagnostic imaging of 61 patients with liver-only metastases were reviewed. Local treatment strategies appeared feasible in 40/61 (65.6%) patients. Five out of 25 patients (20.0%) initially assigned to systemic therapy were deemed eligible for upfront local treatment with curative intent (p = 0.015). In this subgroup, interrater reliability between hepatobiliary surgeons was substantial (ICC: 0.704, 95% CI: 0.536-0.838, n = 25). CONCLUSION Assessment of treatment strategy by a dedicated multidisciplinary panel including liver experts may result in an increased number of patients eligible for potentially curative treatment and reduce undertreatment of patients suffering from liver-only CRLM.
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Affiliation(s)
- T Hellingman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands.
| | - M E de Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - J J A Joosten
- Dijklander Hospital, Department of Surgery, Maelsonstraat 3, Hoorn, the Netherlands
| | - M R Meijerink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - J J J de Vries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - J W D de Waard
- Dijklander Hospital, Department of Surgery, Maelsonstraat 3, Hoorn, the Netherlands
| | - A A van Zweeden
- Amstelland Hospital, Department of Internal Medicine, Laan van de Helende Meesters 8, Amstelveen, the Netherlands
| | - B M Zonderhuis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - G Kazemier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
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25
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Huang J, Chen G, Liu H, Zhang Y, Tang R, Huang Q, Fu K, Peng X, Xiao S. Surgery improves the prognosis of colon mucinous adenocarcinoma with liver metastases: a SEER-based study. BMC Cancer 2020; 20:908. [PMID: 32967651 PMCID: PMC7510088 DOI: 10.1186/s12885-020-07400-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mucinous adenocarcinoma (MC) is the second most common pathological type of colon carcinoma (CC). Colon cancer liver metastases (CLMs) are common and lethal, and complete resection of the primary tumour and metastases for CLM patients would be beneficial. However, there is still no consensus on the role of surgery for MC with liver metastases (M-CLM). METHODS Patients diagnosed with M-CLM or classical adenocarcinoma with CLM (A-CLM) from 2010 to 2013 in the Surveillance, Epidemiology, and End Results (SEER) database were retrieved. The clinicopathological features and overall survival (OS) and cancer-specific survival (CSS) data were compared and analysed. RESULTS The results showed that the M-CLM group had a larger tumour size, more right colon localizations, higher pT and pN stages, more female patients, and more retrieved and positive lymph nodes and accounted for a higher proportion of surgeries than the A-CLM group. The OS and CSS of M-CLM patients who underwent any type of surgery were significantly better than those of patients who did not undergo any surgery, but poorer than those of A-CLM patients who underwent surgery. Meanwhile, the OS and CSS of M-CLM and A-CLM patients who did not undergo any surgery were comparable. Compared with hemicolectomy, partial colectomy led to similar or better OS and CSS for M-CLM, and surgery was an independent protective factor for long-term survival in M-CLM. CONCLUSIONS M-CLM had distinct clinicopathological characteristics from A-CLM, and surgery could improve the survival and is an independent favourable prognostic factor for M-CLM. In addition, partial colectomy might be a non-inferiority choice as hemicolectomy for M-CLM according to the results from this study.
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Affiliation(s)
- Jia Huang
- Institute of Clinical Medicine of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China.,Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Guodong Chen
- Department of Surgery of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Huan Liu
- Department of Surgery of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Yiwei Zhang
- Department of Surgery of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Rong Tang
- Department of Gastrointestinal Surgery of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Qiulin Huang
- Department of Gastrointestinal Surgery of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Kai Fu
- Institute of Molecular Precision Medicine and Hunan Key Laboratory of Molecular Precision Medicine, and Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
| | - Xiuda Peng
- Department of Surgery of the Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China.
| | - Shuai Xiao
- Institute of Clinical Medicine of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China. .,Department of Gastrointestinal Surgery of the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China.
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26
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Höppener DJ, Nierop PMH, Hof J, Sideras K, Zhou G, Visser L, Gouw ASH, de Jong KP, Sprengers D, Kwekkeboom J, Vermeulen PB, Grünhagen DJ, Verhoef C. Enrichment of the tumour immune microenvironment in patients with desmoplastic colorectal liver metastasis. Br J Cancer 2020; 123:196-206. [PMID: 32418992 PMCID: PMC7374625 DOI: 10.1038/s41416-020-0881-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/08/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with resected colorectal liver metastasis (CRLM) who display only the desmoplastic histopathological growth pattern (dHGP) exhibit superior survival compared to patients with any non-desmoplastic growth (non-dHGP). The aim of this study was to compare the tumour microenvironment between dHGP and non-dHGP. METHODS The tumour microenvironment was investigated in three cohorts of chemo-naive patients surgically treated for CRLM. In cohort A semi-quantitative immunohistochemistry was performed, in cohort B intratumoural and peritumoural T cells were counted using immunohistochemistry and digital image analysis, and in cohort C the relative proportions of individual T cell subsets were determined by flow cytometry. RESULTS One hundred and seventeen, 34, and 79 patients were included in cohorts A, B, and C, with dHGP being observed in 27%, 29%, and 15% of patients, respectively. Cohorts A and B independently demonstrated peritumoural and intratumoural enrichment of cytotoxic CD8+ T cells in dHGP, as well as a higher CD8+/CD4+ ratio (cohort A). Flow cytometric analysis of fresh tumour tissues in cohort C confirmed these results; dHGP was associated with higher CD8+ and lower CD4+ T cell subsets, resulting in a higher CD8+/CD4+ ratio. CONCLUSION The tumour microenvironment of patients with dHGP is characterised by an increased and distinctly cytotoxic immune infiltrate, providing a potential explanation for their superior survival.
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Affiliation(s)
- Diederik J Höppener
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Pieter M H Nierop
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost Hof
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kostandinos Sideras
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Guoying Zhou
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Lydia Visser
- Department of Pathology and Medical Biology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jaap Kwekkeboom
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Peter B Vermeulen
- Translational Cancer Research Unit (GZA Hospitals and University of Antwerp), Antwerp, Belgium
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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Brunsell TH, Sveen A, Bjørnbeth BA, Røsok BI, Danielsen SA, Brudvik KW, Berg KCG, Johannessen B, Cengija V, Abildgaard A, Guren MG, Nesbakken A, Lothe RA. High Concordance and Negative Prognostic Impact of RAS/BRAF/PIK3CA Mutations in Multiple Resected Colorectal Liver Metastases. Clin Colorectal Cancer 2019; 19:e26-e47. [PMID: 31982351 DOI: 10.1016/j.clcc.2019.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/11/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence and clinical implications of genetic heterogeneity in patients with multiple colorectal liver metastases remain largely unknown. In a prospective series of patients undergoing resection of colorectal liver metastases, the aim was to investigate the inter-metastatic and primary-to-metastatic heterogeneity of mutations in KRAS, NRAS, BRAF, and PIK3CA and their prognostic impact. PATIENTS AND METHODS We analyzed the mutation status among 372 liver metastases and 78 primary tumors from 106 patients by methods used in clinical routine testing, by Sanger sequencing, by next-generation sequencing (NGS), and/or by droplet digital polymerase chain reaction. The 3-year cancer-specific survival (CSS) was analyzed using the Kaplan-Meier method. RESULTS Although Sanger sequencing indicated inter-metastatic mutation heterogeneity in 14 of 97 patients (14%), almost all cases were refuted by high-sensitive NGS. Also, heterogeneity among metastatic deposits was concluded only for PIK3CA in 2 patients. Similarly, primary-to-metastatic heterogeneity was indicated in 8 of 78 patients (10%) using Sanger sequencing but for only 2 patients after NGS, showing the emergence of 1 KRAS and 1 PIK3CA mutation in the metastatic lesions. KRAS mutations were present in 53 of 106 patients (50%) and were associated with poorer 3-year CSS after liver resection (37% vs. 61% for KRAS wild-type; P = .004). Poor prognostic associations were found also for the combination of KRAS/NRAS/BRAF mutations compared with triple wild-type (P = .002). CONCLUSION Intra-patient mutation heterogeneity was virtually undetected, both between the primary tumor and the liver metastases and among the metastatic deposits. KRAS mutations separately, and KRAS/NRAS/BRAF mutations combined, were associated with poor patient survival after partial liver resection.
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Affiliation(s)
- Tuva Høst Brunsell
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anita Sveen
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Atle Bjørnbeth
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Bård I Røsok
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Stine Aske Danielsen
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Kristoffer Watten Brudvik
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Kaja C G Berg
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjarne Johannessen
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vanja Cengija
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Andreas Abildgaard
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Marianne Grønlie Guren
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Arild Nesbakken
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Ragnhild A Lothe
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
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28
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Kron P, Linecker M, Jones RP, Toogood GJ, Clavien PA, Lodge JPA. Ablation or Resection for Colorectal Liver Metastases? A Systematic Review of the Literature. Front Oncol 2019; 9:1052. [PMID: 31750233 PMCID: PMC6843026 DOI: 10.3389/fonc.2019.01052] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Successful use of ablation for small hepatocellular carcinomas (HCC) has led to interest in the role of ablation for colorectal liver metastases (CRLM). However, there remains a lack of clarity about the use of ablation for colorectal liver metastases (CRLM), specifically its efficacy compared with hepatic resection. Methods: A systematic review of the literature on ablation or resection of colorectal liver metastases was performed using MEDLINE, Cochrane Library, and Embase until December 2018. The aim of this study was to summarize the evidence for ablation vs. resection in the treatment of CRLM. Results: This review identified 1,773 studies of which 18 were eligible for inclusion. In the majority of the studies, overall survival (OS) and disease-free survival (DFS) were significantly higher and local recurrence (LR) rates were significantly lower in the resection groups. On subgroup analysis of solitary CRLM, resection was associated with improved OS, DFS, and reduced LR. Three series assessed the outcome of resection vs. ablation for technically resectable CRLM, and showed improved outcome in the resection group. In fact, there were no studies showing a survival advantage of ablation compared to resection in the treatment of CRLM. Conclusions: Resection remains the "gold standard" in the treatment of CRLM and should not be replaced by ablation at present. This review supports the use of ablation only as an adjunct to resection and as a single treatment option when resection is not safely possible.
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Affiliation(s)
- Philipp Kron
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Michael Linecker
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert P Jones
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Giles J Toogood
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - J P A Lodge
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
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Deng G, Li H, Jia G, Fang D, Tang Y, Xie J, Chen K, Chen Z. Parenchymal-sparing versus extended hepatectomy for colorectal liver metastases: A systematic review and meta-analysis. Cancer Med 2019; 8:6165-6175. [PMID: 31464101 PMCID: PMC6797569 DOI: 10.1002/cam4.2515] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/25/2019] [Accepted: 08/11/2019] [Indexed: 02/05/2023] Open
Abstract
AIMS To assess the safety and efficacy of parenchymal-sparing hepatectomy (PSH) as a treatment of colorectal liver metastases (CLM). METHODS A comprehensive medical literature search was performed. Perioperative and long-term survival outcomes were pooled. Subgroup analysis and meta-regression analysis were performed to identify potential sources of heterogeneity. RESULTS A total of 18 studies comprising 7081 CLM patients were eligible for this study. The PSH was performed on 3974 (56.1%) patients. We found that the OS (overall survival; hazard ratio [HR] = 1.01, 95% confidence interval [CI]: 0.94-1.08) and RFS (recurrence-free survival; HR = 1.00, 95% CI: 0.94-1.07) were comparable between non-PSH and PSH group. The perioperative outcomes were better in PSH than in non-PSH group. Non-PSH group was significantly associated with longer operative time (standard mean difference [SMD] = 1.17, 95% CI: 0.33-2.00), increased estimated blood loss (SMD = 1.36, 95% CI: 0.64-2.07), higher intraoperative transfusion rate (risk ratio [RR] = 2.27, 95% CI: 1.60-3.23), and more postoperative complications (RR = 1.39, 95% CI: 1.16-1.66). Meta-regression analyses revealed that no variable influenced the association between surgical types and the survival outcomes. CONCLUSIONS This study shows that PSH is associated with better perioperative outcomes without compromising oncological outcomes. Given the increasing incidence of hepatic parenchyma, the PSH treatment offers a greater opportunity of repeat resection for intrahepatic recurrent tumors. It should be considered as an effective surgical approach for CLM.
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Affiliation(s)
- Gang Deng
- Department of Liver Surgery and Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Hui Li
- Department of Liver Surgery and Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Gui‐qing Jia
- Department of Liver Surgery and Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Dan Fang
- Department of Breast SurgeryAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - You‐yin Tang
- Department of Liver Surgery and Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Jie Xie
- Department of Liver Surgery and Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Ke‐fei Chen
- Department of Liver Surgery and Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Zhe‐yu Chen
- Department of Liver Surgery and Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
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30
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Huiskens J, Bolhuis K, Engelbrecht MR, De Jong KP, Kazemier G, Liem MS, Verhoef C, de Wilt JH, Punt CJ, van Gulik TM. Outcomes of Resectability Assessment of the Dutch Colorectal Cancer Group Liver Metastases Expert Panel. J Am Coll Surg 2019; 229:523-532.e2. [PMID: 31520695 DOI: 10.1016/j.jamcollsurg.2019.08.1445] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decision making on optimal treatment strategy in patients with initially unresectable colorectal cancer liver metastases (CRLM) remains complex because uniform criteria for (un)resectability are lacking. This study reports on the feasibility and short-term outcomes of The Dutch Colorectal Cancer Group Liver Expert Panel. STUDY DESIGN The Expert Panel consists of 13 hepatobiliary surgeons and 4 radiologists. Resectability assessment is performed independently by 3 randomly assigned surgeons, and CRLM are scored as resectable, potentially resectable, or permanently unresectable. In absence of consensus, 2 additional surgeons are invited for a majority consensus. Patients with potentially resectable or unresectable CRLM at baseline are evaluated every 2 months of systemic therapy. Once CRLM are considered resectable, a treatment strategy is proposed. RESULTS Overall, 398 panel evaluations in 183 patients were analyzed. The median time to panel conclusion was 7 days (interquartile range [IQR] 5-11 days). Intersurgeon disagreement was observed in 205 (52%) evaluations, with major disagreement (resectable vs permanently unresectable) in 42 (11%) evaluations. After systemic treatment, 106 patients were considered to have resectable CRLM, 84 of whom (79%) underwent a curative procedure. R0 resection (n = 41), R0 resection in combination with ablative treatment (n = 26), or ablative treatment only (n = 4) was achieved in 67 of 84 (80%) patients. CONCLUSIONS This study analyzed prospective resectability evaluation of patients with CRLM by a panel of radiologists and liver surgeons. The high rate of disagreement among experienced liver surgeons reflects the complexity in defining treatment strategies for CRLM and supports the use of a panel rather than a single-surgeon decision.
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Affiliation(s)
- Joost Huiskens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Bolhuis
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Marc Rw Engelbrecht
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Koert P De Jong
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC, VU University, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mike Sl Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Cornelis Ja Punt
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Brunsell TH, Cengija V, Sveen A, Bjørnbeth BA, Røsok BI, Brudvik KW, Guren MG, Lothe RA, Abildgaard A, Nesbakken A. Heterogeneous radiological response to neoadjuvant therapy is associated with poor prognosis after resection of colorectal liver metastases. Eur J Surg Oncol 2019; 45:2340-2346. [PMID: 31350075 DOI: 10.1016/j.ejso.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/22/2019] [Accepted: 07/08/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Surgery combined with perioperative chemotherapy has become standard of care in patients with resectable colorectal liver metastases. However, poor outcome is expected for a significant subgroup. The clinical implications of inter-metastatic heterogeneity remain largely unknown. In a prospective, population-based series of patients undergoing resection of multiple colorectal liver metastases, the aim was to investigate the prevalence and prognostic impact of heterogeneous response to neoadjuvant chemotherapy. MATERIALS AND METHODS Radiological response to treatment was evaluated in a lesion-specific manner in 2-5 metastases per patient. Change of lesion diameter was evaluated and response/progression was classified according to three different size thresholds; 3, 4 and 5 mm. A heterogeneous response was defined as progression and response of different metastases in the same patient. RESULTS In total, 142 patients with 585 liver metastases were examined with the same radiological method (MRI or CT) before and after neoadjuvant treatment. Heterogeneous response to treatment was seen in 16 patients (11%) using the 3 mm size change threshold, and this group had a 5-year cancer-specific survival of 19% compared to 49% for patients with response in all lesions (p = 0.003). Cut-off values of 4-5 mm were less sensitive for detecting a heterogeneous response, but the survival difference was similar and significant. CONCLUSION A subgroup of patients with multiple colorectal liver metastases had heterogeneous radiological response to neoadjuvant chemotherapy and poor prognosis. The evaluation of response pattern is easy to perform, feasible in clinical practice and, if validated, a promising biomarker for treatment decisions.
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Affiliation(s)
- Tuva Høst Brunsell
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, POB 1171 Blindern, N-0318, Oslo, Norway.
| | - Vanja Cengija
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway.
| | - Anita Sveen
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, POB 1171 Blindern, N-0318, Oslo, Norway.
| | - Bjørn Atle Bjørnbeth
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway.
| | - Bård I Røsok
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway.
| | - Kristoffer Watten Brudvik
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway.
| | - Marianne Grønlie Guren
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Department of Oncology, Oslo University Hospital, POB 4956 Nydalen, N-0424, Oslo, Norway.
| | - Ragnhild A Lothe
- Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, POB 1171 Blindern, N-0318, Oslo, Norway.
| | - Andreas Abildgaard
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway.
| | - Arild Nesbakken
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, POB 1171 Blindern, N-0318, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, POB 4950 Nydalen, N-0424, Oslo, Norway.
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Saad AM, Abdel-Rahman O. Initial systemic chemotherapeutic and targeted therapy strategies for the treatment of colorectal cancer patients with liver metastases. Expert Opin Pharmacother 2019; 20:1767-1775. [PMID: 31314604 DOI: 10.1080/14656566.2019.1642324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: The liver is the most common metastatic site in colorectal cancer with more than half the patients developing a liver metastasis either at the time of their diagnosis (synchronous) or later (metachronous). Surgical resection remains the principal curative approach that offers significant survival improvements. However, upfront surgery is only possible in about 10-20% of patients at the time of diagnosis, making the consideration of other treatment modalities essential. Areas covered: In this review, the authors provide an overview of the standard approaches for the initial management of patients with colorectal cancer with liver metastases. They then provide an up-to-date discussion of first-line systemic chemotherapy/targeted therapy options in the contexts of initially resectable and unresectable disease and review toxicities and complications following these options. Expert opinion: Advances in chemotherapeutic agents and biological targeted therapies have improved the prognosis of colorectal cancer with liver metastases. However, there is still no 'single best approach', making further trials necessary to provide more evidence.
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Affiliation(s)
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Ain Shams University , Cairo , Egypt.,Department of Oncology, University of Alberta, Cross Cancer Institute , Edmonton , Alberta , Canada
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33
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Höppener DJ, Nierop PMH, van Amerongen MJ, Olthof PB, Galjart B, van Gulik TM, de Wilt JHW, Grünhagen DJ, Rahbari NN, Verhoef C. The Disease-Free Interval Between Resection of Primary Colorectal Malignancy and the Detection of Hepatic Metastases Predicts Disease Recurrence But Not Overall Survival. Ann Surg Oncol 2019; 26:2812-2820. [PMID: 31147988 PMCID: PMC6682566 DOI: 10.1245/s10434-019-07481-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/11/2022]
Abstract
Introduction The disease-free interval (DFI) between resection of primary colorectal cancer (CRC) and diagnosis of liver metastases is considered an important prognostic indicator; however, recent analyses in metastatic CRC found limited evidence to support this notion. Objective The current study aims to determine the prognostic value of the DFI in patients with resectable colorectal liver metastases (CRLM). Methods Patients undergoing first surgical treatment of CRLM at three academic centers in The Netherlands were eligible for inclusion. The DFI was defined as the time between resection of CRC and detection of CRLM. Baseline characteristics and Kaplan–Meier survival estimates were stratified by DFI. Cox regression analyses were performed for overall (OS) and disease-free survival (DFS), with the DFI entered as a continuous measure using a restricted cubic spline function with three knots. Results In total, 1374 patients were included. Patients with a shorter DFI more often had lymph node involvement of the primary, more frequently received neoadjuvant chemotherapy for CRLM, and had higher number of CRLM at diagnosis. The DFI significantly contributed to DFS prediction (p =0.002), but not for predicting OS (p =0.169). Point estimates of the hazard ratio (95% confidence interval) for a DFI of 0 versus 12 months and 0 versus 24 months were 1.284 (1.114–1.480) and 1.444 (1.180–1.766), respectively, for DFS, and 1.111 (0.928–1.330) and 1.202 (0.933–1.550), respectively, for OS. Conclusion The DFI is of prognostic value for predicting disease recurrence following surgical treatment of CRLM, but not for predicting OS outcomes. Electronic supplementary material The online version of this article (10.1245/s10434-019-07481-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diederik J Höppener
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Pieter M H Nierop
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martinus J van Amerongen
- Department of Radiology, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Pim B Olthof
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Boris Galjart
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Nuh N Rahbari
- Department of Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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Histopathological growth patterns of colorectal liver metastasis exhibit little heterogeneity and can be determined with a high diagnostic accuracy. Clin Exp Metastasis 2019; 36:311-319. [PMID: 31134394 PMCID: PMC6611753 DOI: 10.1007/s10585-019-09975-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/22/2019] [Indexed: 02/08/2023]
Abstract
Colorectal liver metastases (CRLM) exhibit distinct histopathological growth patterns (HGPs) that are indicative of prognosis following surgical treatment. This study aims to assess the reliability and replicability of this histological biomarker. Within and between metastasis HGP concordance was analysed in patients who underwent surgery for CRLM. An independent cohort was used for external validation. Within metastasis concordance was assessed in CRLM with ≥ 2 tissue blocks. Similarly, concordance amongst multiple metastases was determined in patients with ≥ 2 resected CRLM. Diagnostic accuracy [expressed in area under the curve (AUC)] was compared by number of blocks and number of metastases scored. Interobserver agreement (Cohen’s k) compared to the gold standard was determined for a pathologist and a PhD candidate without experience in HGP assessment after one and two training sessions. Both the within (95%, n = 825) and the between metastasis (90%, n = 363) HGP concordance was high. These results could be replicated in the external validation cohort with a within and between metastasis concordance of 97% and 94%, respectively. Diagnostic accuracy improved when scoring 2 versus 1 blocks(s) or CRLM (AUC = 95.9 vs. 97.7 [p = 0.039] and AUC = 96.5 vs. 93.3 [p = 0.026], respectively), but not when scoring 3 versus 2 blocks or CRLM (both p > 0.2). After two training sessions the interobserver agreement for both the pathologist and the PhD candidate were excellent (k = 0.953 and k = 0.951, respectively). The histopathological growth patterns of colorectal liver metastasis exhibit little heterogeneity and can be determined with a high diagnostic accuracy, making them a reliable and replicable histological biomarker.
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Gustin P, Botticella A, Tselikas L, Mercier O, Le Péchoux C, Levy A. Prise en charge thérapeutique des cancers bronchiques non à petites cellules oligoprogressifs. Rev Mal Respir 2019; 36:519-526. [DOI: 10.1016/j.rmr.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/12/2018] [Indexed: 11/25/2022]
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Hand F, Sanabria Mateos R, Durand M, Fennelly D, McDermott R, Maguire D, Geoghegan J, Winter D, Hoti E. Multivisceral Resection for Locally Invasive Colorectal Liver Metastases: Outcomes of a Matched Cohort Analysis. Dig Surg 2018; 35:514-519. [PMID: 29346790 DOI: 10.1159/000485198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Local invasion of adjacent viscera by colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to curative hepatic resection. A growing number of observational analyses have illustrated the feasibility of such resections; however, the evidence base is at best heterogeneous with a lack of evidence comparing similar patient groups. We aimed to evaluate the outcomes of hepatectomy for CRLM when combined with other viscera and compare to a matched cohort of isolated hepatic resections. METHODS From 2005 to 2015, 523 patients underwent hepatic resection for CRLM at our institution, 19 of whom underwent hepatectomy with extrahepatic resection. A 3: 1 matched cohort analysis was performed between those who underwent isolated hepatectomy (control group) and those who underwent hepatectomy with extrahepatic resection (combined group). Clinicopathological data were reviewed along with 30-day postoperative morbidity and mortality. Furthermore, overall survival for the multivisceral cohort was compared to all other isolated hepatectomies over the same time period. RESULTS Nineteen patients underwent liver resection accompanied by either/or diaphragmatic resection (n = 13), major vein resection and reconstruction (n = 5), and visceral resection (n = 3). Maximum tumor size was significantly larger in the combined group (60.58 vs. 15.34 mm p < 0.0001). Postoperative morbidity was similar in both groups (p = 0.41). Following multivisceral resection, 1-, 3- and 5-year survival rates were 75, 56.6, and 25.7% respectively. Overall survival showed no significant difference between combined and control groups (p = 0.78). Similarly, when compared to the total cohort of isolated liver resections (n = 504), no significant difference in overall mortality was noted. CONCLUSION In patients presenting with concomitant CRLM and extrahepatic extension where R0 margins can be achieved, this present study supports the rationale to proceed to -surgery with comparable morbidity and mortality rates to -isolated hepatectomy.
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Affiliation(s)
- Fiona Hand
- Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Rebeca Sanabria Mateos
- Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Michael Durand
- Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - David Fennelly
- Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Ray McDermott
- Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Donal Maguire
- Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Justin Geoghegan
- Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Des Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Emir Hoti
- Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
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Huang Z, Zheng W, Zhang YJ, Xu L, Chen JB, Chen JC, Chen MS, Zhou Z. Assessing Hepatic Fibrosis Using 2-D Shear Wave Elastography in Patients with Liver Tumors: A Prospective Single-Center Study. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2522-2529. [PMID: 28807448 DOI: 10.1016/j.ultrasmedbio.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/27/2017] [Accepted: 07/07/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to investigate the diagnostic performance of 2-D shear wave elastography (2-D-SWE) in evaluations of liver stiffness in patients with liver tumors before resection. A total of 121 consecutive patients with hepatocellular carcinoma (HCC) (n = 93), intra-hepatic cholangiocarcinoma (n = 6), mixed hepatocellular carcinoma and intra-hepatic cholangiocarcinoma (n = 6), liver metastases (n = 10) and benign tumors (n = 6) were prospectively enrolled in this study from June 2015 to March 2016. Three valid 2-D-SWE measurements for each patient and median liver stiffness values were calculated. Fibrosis staging was evaluated according to the METAVIR scoring system. A receiver operating characteristic curve analysis was used to assess diagnostic performance. In this study, we found that median liver stiffness values were significantly higher in patients with primary liver tumors than in those with liver metastases and benign tumors (11.80 kPa vs. 5.85 kPa, p < 0.001). In addition, liver stiffness, assessed using 2-D-SWE, was highly correlated with pathologically confirmed liver fibrosis stage. Liver fibrosis stage and liver stiffness values were analyzed using Spearman's correlation (0.708, p < 0.001). The median liver stiffness values were as follows: F1, 6.7 kPa; F2, 6.33 kPa; F3, 9.2 kPa; F4, 13.7 kPa. The area under the receiver operating characteristic curves of the liver stiffness values that predicted significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 83.5%, 91.6% and 88.1%, respectively. According to the Youden index, the optimal cutoff values for predicting significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 7.05 kPa (sensitivity = 74.6%, specificity = 100.0%), 9.45 kPa (sensitivity = 78.8%, specificity = 100.0%) and 11.1 kPa (sensitivity = 83.1%, specificity = 89.3%), respectively. We conclude that 2-D-SWE is a useful, accurate and non-invasive method for evaluating hepatic fibrosis in patients with liver tumors adapted to hepatectomy (ClinicalTrials.gov ID: NCT02958592).
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Affiliation(s)
- Zhongxi Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Wei Zheng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yao-Jun Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Li Xu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jin-Bin Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jian-Cong Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Min-Shan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhongguo Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
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Huiskens J, Olthof PB, van der Stok EP, Bais T, van Lienden KP, Moelker A, Krumeich J, Roumen RM, Grünhagen DJ, Punt CJA, van Amerongen M, de Wilt JHW, Verhoef C, Van Gulik TM. Does portal vein embolization prior to liver resection influence the oncological outcomes - A propensity score matched comparison. Eur J Surg Oncol 2017; 44:108-114. [PMID: 29126672 DOI: 10.1016/j.ejso.2017.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/21/2017] [Accepted: 09/13/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an ongoing controversy surrounding portal vein embolization (PVE) regarding the short-term safety of PVE and long-term oncological benefit. This study aims to compare survival outcomes of patients subjected to major liver resection for colorectal liver metastases (CRLM) with or without PVE. METHODS All consecutive patients who underwent major liver resection for CRLM in four high volume liver centres between January 2000 and December 2015 were included. Major liver resection was defined as resection of at least three Couinaud liver segments. To reduce selection bias, propensity score matching was performed for PVE and non-PVE patients with overall and disease-free survival as primary endpoints. For matching, all patients who underwent PVE followed by a major liver resection were selected. Patients were matched to patients who had undergone major liver resection without PVE. RESULTS Of 745 patients undergoing major liver resection for CRLM, 53 patients (7%) underwent PVE before liver resection. In the overall cohorts, PVE patients had inferior DFS and a trend towards inferior OS. A total of 46 PVE patients were matched to 46 non-PVE patients to create comparable cohorts and between these two matched cohorts no differences in DFS (3-year DFS 16% vs 9%, p = 0.776) or OS (5-year OS 14% vs 14%, p = 0.866) were found. CONCLUSIONS This retrospective, matched analysis does not suggest a negative impact of PVE on long-term outcomes after liver resection in patients with CRLM.
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Affiliation(s)
- Joost Huiskens
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Pim B Olthof
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric P van der Stok
- Department of Surgical Oncology and Gastro Intestinal Surgery, ErasmusMC, Rotterdam, The Netherlands
| | - Thomas Bais
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Krijn P van Lienden
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, ErasmusMC, Rotterdam, The Netherlands
| | - Jan Krumeich
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Rudi M Roumen
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastro Intestinal Surgery, ErasmusMC, Rotterdam, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin van Amerongen
- Department of Radiology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastro Intestinal Surgery, ErasmusMC, Rotterdam, The Netherlands
| | - Thomas M Van Gulik
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Anatomical Resections Improve Disease-free Survival in Patients With KRAS-mutated Colorectal Liver Metastases. Ann Surg 2017; 266:641-649. [PMID: 28657938 DOI: 10.1097/sla.0000000000002367] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the potential clinical advantage of anatomical resection versus nonanatomical resection for colorectal liver metastases, according to KRAS mutational status. BACKGROUND KRAS-mutated colorectal liver metastases (CRLM) are known to be more aggressive than KRAS wild-type tumors. Although nonanatomical liver resections have been demonstrated as a viable approach for CRLM patients with similar oncologic outcomes to anatomical resections, this may not be the case for the subset of KRAS-mutated CRLM. METHODS 389 patients who underwent hepatic resection of CRLM with known KRAS mutational status were identified. Survival estimates were calculated using the Kaplan-Meier method, and multivariable analysis was conducted using the Cox proportional hazards regression model. RESULTS In this study, 165 patients (42.4%) underwent nonanatomical resections and 140 (36.0%) presented with KRAS-mutated CRLM. Median disease-free survival (DFS) in the entire cohort was 21.3 months, whereas 1-, 3-, and 5-year DFS was 67.3%, 34.9%, and 31.5% respectively. Although there was no difference in DFS between anatomical and nonanatomical resections in patients with KRAS wild-type tumors (P = 0.142), a significant difference in favor of anatomical resection was observed in patients with a KRAS mutation (10.5 vs. 33.8 months; P < 0.001). Five-year DFS was only 14.4% in the nonanatomically resected group, versus 46.4% in the anatomically resected group. This observation persisted in multivariable analysis (hazard ratio: 0.45; 95% confidence interval: 0.27-0.74; P = 0.002), when corrected for number of tumors, bilobar disease, and intraoperative ablations. CONCLUSIONS Nonanatomical tissue-sparing hepatectomies are associated with worse DFS in patients with KRAS-mutated tumors. Because of the aggressive nature of KRAS-mutated CRLM, more extensive anatomical hepatectomies may be warranted.
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van Amerongen MJ, Jenniskens SFM, van den Boezem PB, Fütterer JJ, de Wilt JHW. Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases - a meta-analysis. HPB (Oxford) 2017; 19:749-756. [PMID: 28687147 DOI: 10.1016/j.hpb.2017.05.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/21/2017] [Accepted: 05/24/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatic resection and ablative treatments, such as RFA are available treatment options for liver tumors. Advantages and disadvantages of these treatment options in patients with colorectal liver metastases need further evaluation. The purpose of this study was to systematically evaluate the role of radiofrequency ablation (RFA) compared to surgery in the curative treatment of patients with colorectal liver metastases (CRLM). METHODS A systematic search was performed from MEDLINE, EMBASE and the Cochrane Library for studies directly comparing RFA with resection for CRLM, after which variables were evaluated. RESULTS RFA had significantly lower complication rates (OR = 0.44, 95% CI = 0.26-0.75, P = 0.002) compared to resection. However, RFA showed a higher rate of any recurrence (OR = 1.66, 95% CI = 1.15-2.40, P = 0.007), local recurrence (OR = 9.56, 95% CI = 6.85-13.35, P = 0.001), intrahepatic recurrence (OR = 1.96, 95% CI = 1.34-2.87, P = 0.001) and extrahepatic recurrence (OR = 1.21, 95% CI = 0.90-1.63, P = 0.22). Also, 5-year disease-free survival (OR = 2.20, 95% CI = 1.28-3.79, P = 0.005) and overall survival (OR = 2.35, 95% CI = 1.49-3.69, P = 0.001) were significantly lower in patients treated with RFA. CONCLUSIONS RFA showed a significantly lower rate of complications, but also a lower survival and a higher rate of recurrence as compared to surgical resection. All the included studies were subject to possible patient selection bias and therefore randomized clinical trials are needed to accurately evaluate these treatment modalities.
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Affiliation(s)
- Martinus J van Amerongen
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, The Netherlands.
| | - Sjoerd F M Jenniskens
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, The Netherlands
| | | | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, The Netherlands; MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Nijmegen Medical Center, The Netherlands
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Morris E, Treasure T. If a picture is worth a thousand words, take a good look at the picture: Survival after liver metastasectomy for colorectal cancer. Cancer Epidemiol 2017; 49:152-155. [PMID: 28689154 DOI: 10.1016/j.canep.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/04/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION An analysis of NHS data published in by Morris et al. in 2010 is widely used as evidence in support of liver metastasectomy for colorectal cancer and its wider application. Recent evidence concerning better overall survival for patients with metastatic colorectal cancer challenges the notional assumptions about what survival would be without metastasectomy. Earlier detection of metastases for local treatments has not resulted in a survival benefit. MATERIALS AND METHODS The interpretation of its central graphical display is critically reviewed and the common the limitations of the analysis of registry data and resulting immortal time bias are explored. RESULTS AND DISCUSSION Recent evidence, including the 2017 CLOCC trial report make the original interpretation of the analysis suspect. Randomised trials are essential to detect a treatment effect of specific interventions among variable disease progression, selection bias, and multiple and repeated treatments that are inherent in the management of advanced cancer.
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Affiliation(s)
- Eva Morris
- Section of Epidemiology & Biostatistics (Institute of Cancer & Pathology (LICAP) and Institute of Data Analytics (LIDA)), Leeds, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unity (CORU) and Surgical and Interventional Trials Unit (SITU), University College London, London WC1E 6BT, UK
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Treasure T, Williams NR. Best available evidence related to clinical benefit of surgical resection in multimodality treatment of metastatic colorectal cancer indicates that a randomised controlled trial is warranted. Eur J Cancer 2017; 75:310-312. [PMID: 28259014 DOI: 10.1016/j.ejca.2016.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
| | - Norman R Williams
- Surgical & Interventional Trials Unit, Division of Surgery & Interventional Science, University College London, UK
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van der Stok EP, Spaander MCW, Grünhagen DJ, Verhoef C, Kuipers EJ. Surveillance after curative treatment for colorectal cancer. Nat Rev Clin Oncol 2016; 14:297-315. [DOI: 10.1038/nrclinonc.2016.199] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Significant increase of synchronous disease in first-line metastatic colorectal cancer trials: Results of a systematic review. Eur J Cancer 2016; 69:166-177. [DOI: 10.1016/j.ejca.2016.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/19/2016] [Accepted: 09/25/2016] [Indexed: 01/08/2023]
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Ismael HN, Denbo J, Cox S, Crane CH, Das P, Krishnan S, Schroff RT, Javle M, Conrad C, Vauthey J, Aloia T. Biologic mesh spacer placement facilitates safe delivery of dose-intense radiation therapy: A novel treatment option for unresectable liver tumors. Eur J Surg Oncol 2016; 42:1591-6. [PMID: 27296729 DOI: 10.1016/j.ejso.2016.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/04/2016] [Accepted: 05/19/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Patients with unresectable liver tumors who fail initial treatment modalities have a poor prognosis (<1 yr). Although effective, delivery of high dose radiation therapy to these tumors is limited by proximity of radiosensitive bowel. We have previously reported that placement of a biologic mesh spacer (BMS) can effectively displace the bowel allowing for dose-intense radiation to be delivered with low short-term toxicity. The purpose of this study was to assess and report the long-term safety and oncologic outcomes of this cohort. METHODS From 2012 to 2014 seven patients with unresectable hepatic malignancy (6 IHCC, 1 CRLM) underwent BMS (acellular human dermis) placement (2 open, 5 MIS) prior to radiation therapy. Prospective registry data were reviewed for tumor and treatment details, progression, metastasis and survival. RTOG guidelines were used to define radiation toxicities. RESULTS Mean patient age was 50.4 years (30-62 years) and 4 patients were male (57.1%). Prior to surgery, all patients had been treated for an average of 12.5 months with surgery, chemotherapy, radiation and/or TACE. After surgery, all patients recovered well and received a mean radiation dose of 76.1 Gy (58.1-100 Gy) over 13-25 fractions. 1 patient received SBRT; 4 fractions, 10 Gy each. Maximum dose delivered was 100 Gy (Biologic Equivalent Dose of 140 Gy, α/β = 10). Mean time to initiation of radiation therapy was 24 days (12-48 days) from surgery. No significant GI toxicity was recorded, and no GI bleeding or ulcers were observed. Mean follow-up after XRT was 18.2 months (5.5-31 months). Three patients had no loco-regional progression of disease. 2 patients had infield progression of liver disease and another had progressive lymphadenopathy. 3 patients developed pulmonary metastasis, at a mean time to distant failure of 3 months. There are 4 survivors over 2-years from surgery. CONCLUSION For patients with unresectable liver tumors, placement of a BMS enhances the safety and efficacy of high-dose radiotherapy, providing a survival benefit via delay in time to progression compared to traditional treatments with no significant short or long term GI toxicity.
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Affiliation(s)
- H N Ismael
- Department of Surgery, The University of Texas Health Science Center at Tyler, Tyler, TX, USA.
| | - J Denbo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - S Cox
- Department of Surgery, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - C H Crane
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Krishnan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R T Schroff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - M Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - C Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - J Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - T Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
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