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Yu G, Liu S, Wang Z, Liu Q, Ren H, Hu W. Palliative primary tumor resection may not offer survival benefits for patients with unresectable metastatic colorectal neuroendocrine neoplasms, one multicenter retrospective cohort study. BMC Surg 2024; 24:85. [PMID: 38475759 DOI: 10.1186/s12893-024-02380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The efficacy of palliative primary tumor resection (PTR) in improving prognosis for patients with unresectable metastatic colorectal neuroendocrine neoplasms (NENs) has not been fully explored. METHODS We performed one retrospective cohort study and recruited 68 patients with unresectable metastatic colorectal NENs from two Chinese medical centers between 2000 and 2022. All patients were assigned to PTR group and no PTR group. The clinicopathological manifestation data were carefully collected, and the survival outcomes were compared between the two groups using Kaplan-Meier methods. Propensity score matching (PSM) was conducted to minimize confounding bias. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify prognostic factors. RESULTS A total of 32 patients received PTR, and the other 36 patients did not. The median progression-free survival (PFS) and overall survival (OS) times were 4 and 22 months in the whole cohort, respectively. For patients who received no PTR, the median OS was 16 months, and the 1-year OS rate and 3-year OS rate were 56.4% and 39.6%, respectively. For patients who received PTR, the median OS was 24 months, and the 1-year OS rate and 3-year OS rate were 67.9% and 34.1%, respectively. However, the Kaplan-Meier survival curves and log-rank test demonstrated no significant survival difference between the two groups (P = 0.963). Moreover, palliative PTR was also not confirmed as a prognostic factor in subsequent univariable and multivariable Cox proportional hazards regression analyses in both the original and matched cohorts. Only histological differentiation was identified as an independent prognostic factor affecting PFS [hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.02-3.41, P = 0.043] and OS [HR = 3.70, 95% CI: 1.09-12.48, P = 0.035] in the original cohort. CONCLUSIONS Palliative PTR may not offer survival benefits for patients with unresectable metastatic colorectal NENs.
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Affiliation(s)
- Guozhi Yu
- Department of Colorectal and Anal Surgery, Beijing Erlonglu Hospital, Beijing, 100016, China
| | - Shen Liu
- Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Zhijie Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Qian Liu
- Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Hongchang Ren
- Department of General Surgery, Strategic Support Force Medical Center, No.9, Anxiang North, Desheng Gate, Chaoyang District, Beijing, 100101, China.
| | - Wenhui Hu
- Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Yu W, Xie Q, Li J, Tang J, Yang W, Tao Y. Salvage 125I brachytherapy for liver metastases of colorectal cancer in anatomically challenging locations after failure of systemic chemotherapy-A retrospective study. Brachytherapy 2022; 21:592-598. [PMID: 35750620 DOI: 10.1016/j.brachy.2022.05.006] [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: 02/09/2022] [Revised: 04/28/2022] [Accepted: 05/20/2022] [Indexed: 11/02/2022]
Abstract
PURPSOE Colorectal cancer liver metastasis (CCLM) in anatomically challenging locations is difficult to treat. This retrospective study aimed to evaluate the effectiveness and safety of permanent 125I seeds implantation (ISI) for treatment of CCLM in anatomically challenging locations after failure of systemic chemotherapy. METHODS AND MATERIALS A total of 31 liver metastases (in 25 patients) were treated by ISI under computerized tomography guidance from January 2011 to December 2017. Post-treatment follow-up was for 40 months. Adverse events were classified using the National Cancer Institute's Common Terminology Criteria for Adverse Events. Tumor response was evaluated by the mRECIST criteria. Objective response rate, overall survival rate, and complications were retrospectively analyzed. RESULTS All ISI procedures were performed successfully. Most patients only complained of fatigue and mild pain after ISI. Only one patient had liver rupture during the procedure. Serum alanine aminotransferase and aspartate aminotransferase levels at 1 month after ISI were not significantly different from pre-procedure levels (p > 0.05). Computed tomography at 6 months after ISI treatment showed completed response in 11 (11/31, 35.5%) lesions, partial response in 14 (14/31, 45.2%) lesions, stable disease in 4 (4/31, 12.9%) lesions, and disease progression in 2 (2/31, 6.5%) lesions; thus, the objective response rate was 80.6%. Median survival was for 12 months. The 1 and 2 year overall survival rates were 52.0% and 20.0%, respectively. CONCLUSIONS 125I seeds implantation for CCLM in anatomically challenging locations is safe and effective. Survival benefit is limited in the salvage setting where patients have high intrahepatic tumor load after failed systemic chemotherapy.
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Affiliation(s)
- Wenhui Yu
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China.
| | - Qigen Xie
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Jie Li
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Jie Tang
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Wenge Yang
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Yun Tao
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
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Wahl RL, Hicks RJ. PET Diagnosis and Response Monitoring in Oncology. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Krasnodebski M, Kim BJ, Wei SH, Velasco JD, Nishioka Y, Vauthey JN. Chemotherapy in combination with resection for colorectal liver metastases – current evidence. SURGERY IN PRACTICE AND SCIENCE 2020. [DOI: 10.1016/j.sipas.2020.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Yang Y, Lu Y, Jiang W, Zhu J, Yan S. Individualized prediction of survival benefit from primary tumor resection for patients with unresectable metastatic colorectal cancer. World J Surg Oncol 2020; 18:193. [PMID: 32746835 PMCID: PMC7401291 DOI: 10.1186/s12957-020-01972-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background The impact of primary tumor resection (PTR) on the prognosis of unresectable metastatic colorectal cancer (mCRC) patients remains debatable. We aimed to develop several prognostic nomograms which could be useful in predicting whether patients might benefit from PTR or not. Methods Patients diagnosed as mCRC without resected metastasis were identified from the Surveillance Epidemiology and End Results database and randomly assigned into two groups: a training cohort (6369 patients) and a validation cohort (2774 patients). Univariate and multivariable Cox analyses were performed to identify the independent predictors and construct nomograms that could independently predict the overall survival (OS) of unresectable mCRC patients in PTR and non-PTR groups, respectively. The performance of these nomograms was assessed by the concordance index (C-index), calibration curves, and decision curve analysis (DCA). Results Based on the result of univariate and multivariable Cox analyses, two nomograms were respectively constructed to predict the 1-year OS rates of unresectable mCRC patients when receiving PTR and not. The first one included age, gender, tumor grade, proximal colon, N stage, CEA, chemotherapy, radiotherapy, histology type, brain metastasis, liver metastasis, lung metastasis, and bone metastasis. The second nomogram included age, race, tumor grade, primary site, CEA, chemotherapy, brain metastasis, and bone metastasis. These nomograms showed favorable sensitivity with the C-index range of 0.700–0.725. The calibration curves and DCAs also exhibited adequate fit and ideal net benefits in prognosis prediction and clinical application. Conclusions These practical prognosis nomograms could assist clinicians in making appropriate treatment decisions to effectively manage the disease.
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Affiliation(s)
- Yi Yang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Yujie Lu
- Department of Oncology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Wen Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Su Yan
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
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Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer. Cancers (Basel) 2019; 11:cancers11020218. [PMID: 30769860 PMCID: PMC6406820 DOI: 10.3390/cancers11020218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Secondary resection rates in first-line chemotherapy trials for metastatic colorectal cancer (mCRC) remain below 15%, representing a clear contrast to reports by specialised surgical centres, where progressive liver, peritoneal-surface, and pulmonary surgery increased access to curative-intent treatment. We present a long-term evaluation of oncosurgical management in a single-centre, analysing the aggregate effect of gradual implementation of surgical subspecialties and systemic treatments on mCRC patients’ resection rates and prognosis. Methods: Patients with newly diagnosed mCRC from 2003 to 2014 were retrospectively categorised into palliative treatment (PAT) and curative intent surgery (CIS) and three time periods were analysed for treatment changes and factors associated with survival. Results: Four hundred-twenty patients were treated (PAT:250/CIS:170). Over time periods, the number of presenting patients remained consistent, whereas curative resection rates increased from 29% to 55%, facilitated by an increment of patients undergoing hepatectomy (21 to 35%), pulmonary surgery (6 to 17%), and peritonectomy/intraoperative chemotherapy (0 to 8%). Also, recently, significantly more multi-line systemic treatments were applied. The median survival markedly improved from 21.9 months (2003–2006; 95% confidence interval (CI) 17.3–26.5) to 36.5 months (2011–2014; 95% CI 26.6–46.4; p = 0.018). PAT was a significant factor of poor survival and diagnosis of mCRC in the latest time period was independently associated with a distinctly lower risk for palliative treatment (odds ratio 0.15). Conclusions: In modern eras of medical oncology, achieving appropriate resection rates through utilization of state-of-the-art oncological surgery by dedicated experts represents a cornerstone for long-term survival in mCRC.
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O'Leary C, Greally M, McCaffrey J, Hughes P, Lawler LLP, O'Connell M, Geoghegan T, Farrelly C. Single-institution experience with selective internal radiation therapy (SIRT) for the treatment of unresectable colorectal liver metastases. Ir J Med Sci 2018; 188:43-53. [PMID: 29511912 DOI: 10.1007/s11845-018-1773-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver metastases are the commonest cause of death for patients with colorectal cancer. Growing evidence supports the use of selective internal radiation therapy (SIRT) in combination with conventional chemotherapy regimens for liver-only or liver-dominant unresectable metastatic colorectal cancer. AIMS To measure and evaluate outcomes of the first 20 consecutive patients with unresectable colorectal liver metastasis selected for SIRT in addition to their chemotherapy at a single Irish institution. METHODS Retrospective case series was performed. Patient charts and medical records were reviewed. RESULTS All 20 patients (100%) selected for angiographic workup were subsequently successfully treated with radioembolization. All patients were discharged 1 day post-SIRT. At initial imaging evaluation, 12 (60%) had a partial response in their liver, 2 (10%) had stable disease, and 6 (30%) had liver-specific progressive disease. Median follow up was 10 months (range 6-26). At last follow up, 14 (70%) patients were alive and 6 (30%) deceased. Most recent imaging demonstrated 2 (10%) with a complete response, 7 (35%) had a partial response, 2 (10%) had stable disease, and 9 (45%) had progressive disease within their liver. One patient was downstaged to hepatic resection, and one with a complete hepatic response had his primary sigmoid tumor resected 11 months post-SIRT. CONCLUSIONS SIRT is a safe and effective therapy for certain patients with unresectable colorectal liver metastases. This case series supports our opinion that selected patients should be offered SIRT in concert with their medical oncologist, concomitant with their chemotherapy. Larger multi-center studies are required to more clearly define the patient groups that will derive most benefit from SIRT.
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Affiliation(s)
- Cathal O'Leary
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Megan Greally
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - John McCaffrey
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Peter Hughes
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Leo L P Lawler
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Martin O'Connell
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Tony Geoghegan
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Cormac Farrelly
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.
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Maroney S, de Paz CC, Reeves ME, Garberoglio C, Raskin E, Senthil M, Namm JP, Solomon N. Benefit of Surgical Resection of the Primary Tumor in Patients Undergoing Chemotherapy for Stage IV Colorectal Cancer with Unresected Metastasis. J Gastrointest Surg 2018; 22:460-466. [PMID: 29124549 DOI: 10.1007/s11605-017-3617-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/24/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE Resection of the primary tumor in patients with unresected metastatic colorectal cancer is controversial, and often performed only for palliation of symptoms. Our goal was to determine if resection of the primary tumor in this patient population is associated with improved survival. METHODS This is a retrospective cohort study of the National Cancer Data Base from 2004 to 2012. The study population included all patients with synchronous metastatic colorectal adenocarcinoma who were treated with systemic chemotherapy. The study groups were patients who underwent definitive surgery for the primary tumor and those who did not. Patients were excluded if they had surgical intervention on the sites of metastasis or pathology other than adenocarcinoma. Primary outcome was overall survival. RESULTS Of the 65,543 patients with unresected stage IV colorectal adenocarcinoma undergoing chemotherapy, 55% underwent surgical resection of the primary site. Patients who underwent surgical resection of the primary tumor had improved median survival compared to patients treated with chemotherapy alone (22 vs 13 months, p < .0001). The surgical survival benefit was present for patients who were treated with either multi-agent or single-agent chemotherapy (23 vs 14 months, p < 0.001; 19 vs 9 months, p < 0.001). Surgical resection of the primary tumor was also associated with improved survival when using multivariate analysis with propensity score matching (OR = 0.863; 95% CI [0.805-.924]; HR = 0.914; 95% CI [0.888-0.942]). CONCLUSIONS Our results show that in patients with synchronous unresected stage IV colorectal adenocarcinoma undergoing single- or multi-agent chemotherapy, after adjusting for confounding variables, definitive resection of the primary site was associated with improved overall survival. Large randomized controlled trials are needed to determine if there is a causal relationship between surgery and increased overall survival in this patient population.
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Affiliation(s)
- Sean Maroney
- Department of Surgery, Loma Linda University Health, 11175 Campus Street, Suite 21108, Loma Linda, CA, 92350, USA.
| | | | - Mark E Reeves
- Department of Surgery, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Carlos Garberoglio
- Department of Surgery, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Elizabeth Raskin
- Department of Surgery, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Maheswari Senthil
- Department of Surgery, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Jukes P Namm
- Department of Surgery, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Naveenraj Solomon
- Department of Surgery, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
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Griggs RKL, Pathak S, Poston G. An Overview of the Current Management of Bilobar Colorectal Liver Metastases. Indian J Surg Oncol 2017; 8:600-606. [PMID: 29203994 DOI: 10.1007/s13193-017-0686-6] [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: 11/15/2016] [Accepted: 08/01/2017] [Indexed: 10/19/2022] Open
Abstract
Bilobar colorectal liver metastases (BCRLM) present a challenging scenario for liver surgeons globally. The following article aims to provide an overview of the different strategies which may be utilised in order to successfully manage advanced BCRLM.
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Affiliation(s)
- Rebecca K L Griggs
- Department of Hepatobiliary Surgery, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW UK
| | - Samir Pathak
- Department of Hepatobiliary Surgery, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW UK
| | - Graeme Poston
- Department of Hepatobiliary Surgery, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL UK
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Reiter MJ, Hannemann NP, Schwope RB, Lisanti CJ, Learn PA. Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know. ACTA ACUST UNITED AC 2016. [PMID: 26194812 DOI: 10.1007/s00261-015-0507-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.
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Affiliation(s)
- Michael J Reiter
- Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120 East Loop Road, Stony Brook, NY, 11794, USA.
| | - Nathan P Hannemann
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher J Lisanti
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Peter A Learn
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
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Kaifi JT, Kunkel M, Dicker DT, Joude J, Allen JE, Das A, Zhu J, Yang Z, Sarwani NE, Li G, Staveley-O'Carroll KF, El-Deiry WS. Circulating tumor cell levels are elevated in colorectal cancer patients with high tumor burden in the liver. Cancer Biol Ther 2016; 16:690-8. [PMID: 25785486 DOI: 10.1080/15384047.2015.1026508] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Metastatic spread is the most common cause of cancer-related death in colorectal cancer (CRC) patients, with the liver being the mostly affected organ. Circulating tumor cells (CTCs) are a prognostic marker in stage IV CRC. We hypothesized that tumor burden in the liver correlates with CTC quantity. METHODS Blood (7.5 ml) was prospectively collected from 24 patients with novel stage IV CRC diagnosis. Baseline EpCAM+ CTCs were analyzed with the FDA-approved CellSearch® system. Clinicopathological data were collected, and hepatic tumor burden was determined by radiographic liver volumetry with contrast-enhanced CT scans. CRC primary tumors were immunohistochemically stained for EpCAM expression with BerEP4 monoclonal antibody. Statistical analyses were performed using 2-sample T-test, non-parametric Wilcoxon Rank-Sum test, and Fisher's exact test. RESULTS CTCs were detected n 17 (71%) of 24 patients. The overall mean CTC number as determined by EpCAM-based CellSearch® detection was 6.3 (SEM 2.9). High baseline CTC numbers (≥3) correlated significantly with a high tumor/liver ratio (≥30%), and with high serum CEA levels, as determined by two-sample T-test on log-transformed data and by Fisher's Exact test on categorical data analysis (P < 0.05). The CRC primary tumors were consistently expressing EpCAM by immunostaining. CONCLUSIONS High tumor burden in the liver and high baseline serum CEA levels are associated with high number of baseline CTCs in stage IV CRC patients. Future studies should further investigate the biological role and expression patterns of single CTCs in cancer patients to further improve personalized treatment strategies.
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Li ZM, Peng YF, Du CZ, Gu J. Colon cancer with unresectable synchronous metastases: the AAAP scoring system for predicting the outcome after primary tumour resection. Colorectal Dis 2016; 18:255-63. [PMID: 26400111 DOI: 10.1111/codi.13123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/05/2015] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study was to develop a prognostic scoring system to predict the outcome of patients with unresectable metastatic colon cancer who received primary colon tumour resection. METHOD Patients with confirmed metastatic colon cancer treated at the Peking University Cancer Hospital between 2003 and 2012 were reviewed retrospectively. The correlation of clinicopathological factors with overall survival was analysed using the Kaplan-Meier method and the log-rank test. Independent prognostic factors were identified using a Cox proportional hazards regression model and were then combined to form a prognostic scoring system. RESULTS A total of 110 eligible patients were included in the study. The median survival time was 10.4 months and the 2-year overall survival (OS) rate was 21.8%. Age over 70 years, an alkaline phosphatase (ALP) level over 160 IU/l, ascites, a platelet/lymphocyte ratio (PLR) above 162 and no postoperative therapy were independently associated with a shorter OS in multivariate analysis. Age, ALP, ascites and PLR were subsequently combined to form the so-called AAAP scoring system. Patients were classified into high, medium and low risk groups according to the score obtained. There were significant differences in OS between each group (P < 0.001). CONCLUSION Age, ALP, ascites, PLR and postoperative therapy were independent prognostic factors for survival of patients with metastatic colonic cancer who underwent primary tumour resection. The AAAP scoring system may be a useful tool for surgical decision making.
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Affiliation(s)
- Z M Li
- Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Y F Peng
- Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - C Z Du
- Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - J Gu
- Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
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Hosseini-Nik H, Fischer SE, Moulton CAE, Karbhase G, Menezes RJ, Gallinger S, Jhaveri KS. Diffusion-weighted and hepatobiliary phase gadoxetic acid-enhanced quantitative MR imaging for identification of complete pathologic response in colorectal liver metastases after preoperative chemotherapy. Abdom Radiol (NY) 2016; 41:231-8. [PMID: 26867904 DOI: 10.1007/s00261-015-0572-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperative chemotherapy. METHODS Gadoxetic acid-enhanced liver MRI and DWI were performed after completion of preoperative chemotherapy in patients with CRLM scheduled for liver resection. Metastases were classified as those with complete pathologic response (CR-CRLM) or incomplete response (IR-CRLM) according to postsurgical histopathology. Quantitative analysis was performed on non-contrast-enhanced images and hepatobiliary phase images following gadoxetic acid administration. Apparent diffusion coefficient values (ADC), normalized relative enhancement (NRE), and relative signal intensity difference (RSID) along with their diagnostic measures for detection of CR-CRLM were calculated for all lesions. RESULTS In 23 patients, 10 CR-CRLM and 35 IR-CRLM (mean diameter, 21.2 mm) were evaluated. In CR-CRLM, ADC was significantly higher after exclusion of the outliers (p = 0.030); and RSID was significantly lower (p = 0.008). Combined indices range of ADC = 1.25-1.9 × 10(-3) mm(2)/s, NRE = 0-35% and RSID <120 had 60% sensitivity and 100% specificity for detection of CR-CRLM. CONCLUSION DWI and gadoxetic acid-enhanced MRI appear promising for the detection of CRLM with complete response to preoperative chemotherapy. This could have significant implications for liver resection planning after preoperative chemotherapy.
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de Santibañes M, Alvarez FA, Santos FR, Ardiles V, de Santibañes E. The associating liver partition and portal vein ligation for staged hepatectomy approach using only segments I and IV as future liver remnant. J Am Coll Surg 2014; 219:e5-9. [PMID: 24974268 DOI: 10.1016/j.jamcollsurg.2014.01.070] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/29/2014] [Accepted: 01/29/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Martin de Santibañes
- Hepato-Pancreato-Biliary and Liver Transplant Sections, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Fernando A Alvarez
- Hepato-Pancreato-Biliary and Liver Transplant Sections, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fanny Rodriguez Santos
- Hepato-Pancreato-Biliary and Liver Transplant Sections, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Hepato-Pancreato-Biliary and Liver Transplant Sections, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Hepato-Pancreato-Biliary and Liver Transplant Sections, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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de Mestier L, Neuzillet C, Pozet A, Desot E, Deguelte-Lardière S, Volet J, Karoui M, Kianmanesh R, Bonnetain F, Bouché O. Is primary tumor resection associated with a longer survival in colon cancer and unresectable synchronous metastases? A 4-year multicentre experience. Eur J Surg Oncol 2014; 40:685-91. [PMID: 24630774 DOI: 10.1016/j.ejso.2014.02.236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the survival impact of primary tumor resection (PTR) in patients with metastatic colon cancer (mCC) and unresectable metastases. METHODS We retrospectively studied a multicenter cohort of consecutive mCC patients with unresectable metastases receiving first-line chemotherapy. A weighted Cox proportional regression model was used to balance for clinical variables associated with the probability of undergoing PTR, using inverse probability of treatment weighting (IPTW) based on a propensity score. RESULTS Ninety-six patients were included. PTR was performed in 69 (72%). The rates of secondary resection of metastases (p = 0.02) and bevacizumab administration (p = 0.02) were higher in the PTR group. Raw median overall survival (OS) was 23.1 months (95%CI[14.6-27.8]) in the PTR group and 22.1 months (95%CI[12.3-23.7]) in the non-PTR group (p = 0.11). After adjustment on IPTW, OS was 23.1 months (95%CI[17.0-28.7]) in the PTR group and 17.2 months (95%CI[13.5-22.2]) in the non-PTR group (HR 0.68; 95%CI[0.50-0.93]; p = 0.016). This result remained significant on multivariate analysis (HR 0.71; 95%CI[0.50-1.00]; p = 0.05). CONCLUSION In mCC patients with unresectable metastases receiving chemotherapy, up-front PTR was independently associated with prolonged OS. Patients eligible for secondary metastases resection and/or bevacizumab may benefit the most from PTR. Randomized controlled trials are mandatory.
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Affiliation(s)
- L de Mestier
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France.
| | - C Neuzillet
- Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Clichy, France
| | - A Pozet
- Unit of Methodology and Quality of Life in Oncology, EA 3181, Saint-Jacques University Hospital, Besançon, France
| | - E Desot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - S Deguelte-Lardière
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - J Volet
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - M Karoui
- Department of Digestive Surgery, Pitié-Salpetrière University Hospital, Assistance Publique Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
| | - R Kianmanesh
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - F Bonnetain
- Unit of Methodology and Quality of Life in Oncology, EA 3181, Saint-Jacques University Hospital, Besançon, France
| | - O Bouché
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France.
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Thomay AA, Nagorney DM, Cohen SJ, Sigurdson ER, Truty MJ, Burtness B, Hall MJ, Chun YS. Modern chemotherapy mitigates adverse prognostic effect of regional nodal metastases in stage IV colorectal cancer. J Gastrointest Surg 2014; 18:69-74. [PMID: 24002765 DOI: 10.1007/s11605-013-2329-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 08/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND In colorectal cancer, the involvement of regional lymph nodes with metastasis is an established prognostic factor. The impact of the number of positive nodes on patient outcome with stage IV disease is not well defined. METHODS A retrospective review was performed of 1,421 patients at two tertiary referral centers with stage IV colorectal cancer who underwent primary tumor resection. Associations between regional nodes, lymph node ratio (LNR), and overall survival (OS) from date of diagnosis were analyzed. RESULTS The number of positive regional nodes and LNR correlated with multiple sites of metastases (p < 0.001). Survival was significantly associated with the number of positive nodes and LNR, with a median OS of 43 months with negative nodes, compared to 20 months with ≥7 positive nodes (p < 0.001). The number of regional nodal metastases correlated with OS among 400 patients undergoing resection of liver metastases (p = 0.005) but lost prognostic significance in the subset of 223 patients who underwent hepatectomy with perioperative oxaliplatin- or irinotecan-based chemotherapy (p = 0.48). CONCLUSIONS In stage IV colorectal cancer, an increasing number of positive regional nodes and LNR correlate with multiple sites of metastases and poorer survival. The number of metastatic regional lymph nodes loses prognostic significance with modern chemotherapy in patients undergoing resection of liver metastases.
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Affiliation(s)
- Alan A Thomay
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Kaifi JT, Kunkel M, Zhu J, Dicker DT, Gusani N, Yang Z, Sarwani NE, Li G, Kimchi ET, Staveley-O'Carroll KF, El-Deiry WS. Circulating tumor cells are associated with diffuse spread in stage IV colorectal cancer patients. Cancer Biol Ther 2013; 14:1174-81. [PMID: 24153154 DOI: 10.4161/cbt.26884] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States when combining both genders. Circulating tumor cells (CTCs) are a prognostic marker for stage IV CRC patients. We hypothesized that CTC quantity varies among stage IV CRC populations. METHODS Blood (7.5 ml) was prospectively collected from 90 stage IV CRC patients. EpCAM(+) CTCs were analyzed with the FDA-approved CellSearch(®) system. CRC tumors were immunohistochemically stained for EpCAM expression. Imaging and clinicopathological data were collected. Statistical analysis was performed using correlation analysis, Kruskal-Wallis, Fisher exact, and log-rank test. RESULTS CTCs were detectable in 36/90 (40%) patients. Diffuse CRC metastases were associated with the highest CTC prevalence (24/40 [60%]), in contrast to limited lung (2/19 [11%]) or liver (10/31 [32%]) metastases (P = 0.027). The overall mean CTC number was 2.0 (range 0-56.3). The mean CTC number in patients with diffuse metastases was significantly higher (3.7 [SEM ± 1.7, range 0-56.3]) than with limited lung metastases (0.1 [± 0.1; range 0-1]) or liver metastases (0.9 [± 0.3, range 0-7.0]) (P = 0.001). CRC tumors were consistently expressing EpCAM. CTC numbers did not correlate with serum CEA levels or other routine clinical parameters (P = N.S.). Patients with diffuse metastases had the poorest overall survival (P = 0.0042). CONCLUSIONS CRC patients with diffuse metastases have the highest number of CTCs, in contrast to limited metastases to the liver or lungs. Future studies should correlate CTCs with recurrence patterns in patients with resected CRC lung or liver metastases to investigate whether CTCs represent micrometastatic disease causing early relapses.
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Affiliation(s)
- Jussuf T Kaifi
- Division of Surgical Oncology; Hollings Cancer Center; Medical University of South Carolina; Charleston, SC USA
| | - Miriam Kunkel
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics; Division of Hematology/Oncology; Department of Medicine; Penn State Hershey Cancer Institute; Pennsylvania State University; Hershey, PA USA
| | - Junjia Zhu
- Department of Public Health Sciences; Penn State Hershey Cancer Institute; Pennsylvania State University; Hershey, PA USA
| | - David T Dicker
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics; Division of Hematology/Oncology; Department of Medicine; Penn State Hershey Cancer Institute; Pennsylvania State University; Hershey, PA USA
| | - Niraj Gusani
- Section of Surgical Oncology; Department of Surgery; Penn State Hershey Cancer Institute; Pennsylvania State University; Hershey, PA USA
| | - Zhaohai Yang
- Department of Pathology; Penn State Hershey Cancer Institute; Pennsylvania State University; Hershey, PA USA
| | - Nabeel E Sarwani
- Department of Radiology, Penn State Hershey Cancer Institute; Pennsylvania State University; Hershey, PA USA
| | - Guangfu Li
- Division of Surgical Oncology; Hollings Cancer Center; Medical University of South Carolina; Charleston, SC USA
| | - Eric T Kimchi
- Division of Surgical Oncology; Hollings Cancer Center; Medical University of South Carolina; Charleston, SC USA
| | - Kevin F Staveley-O'Carroll
- Division of Surgical Oncology; Hollings Cancer Center; Medical University of South Carolina; Charleston, SC USA
| | - Wafik S El-Deiry
- Laboratory of Translational Oncology and Experimental Cancer Therapeutics; Division of Hematology/Oncology; Department of Medicine; Penn State Hershey Cancer Institute; Pennsylvania State University; Hershey, PA USA
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Zeestraten ECM, Benard A, Reimers MS, Schouten PC, Liefers GJ, van de Velde CJH, Kuppen PJK. The prognostic value of the apoptosis pathway in colorectal cancer: a review of the literature on biomarkers identified by immunohistochemistry. BIOMARKERS IN CANCER 2013; 5:13-29. [PMID: 24179395 PMCID: PMC3791955 DOI: 10.4137/bic.s11475] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Research towards biomarkers that predict patient outcome in colorectal cancer (CRC) is rapidly expanding. However, none of these biomarkers have been recommended by the American Association of Clinical Oncology or the European Group on Tumor Markers. Current staging criteria result in substantial under-and over-treatment of CRC patients. Evasion of apoptosis, a characteristic feature of tumorigenesis, is known to correlate with patient outcome. We reviewed the literature on immunohistochemistry-based studies between 1998 and 2011 describing biomarkers in this pathway in CRC and identified 26 markers. Most frequently described were p53, Bcl-2, survivin, and the Fas and TRAILR1 receptors and their ligands. None of the studies reviewed provided sufficient support for implementing a single marker into current clinical practice. This is likely due to the complex biology of this pathway. We suggest focusing on the combination of key markers within the apoptosis pathway that together represent an ‘apoptotic tumor profile’, which better reflects the status of this pathway in a tumor.
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Metrakos P, Kakiashvili E, Aljiffry M, Hassanain M, Chaudhury P. Role of Surgery in the Diagnosis and Management of Metastatic Cancer. EXPERIMENTAL AND CLINICAL METASTASIS 2013:381-399. [DOI: 10.1007/978-1-4614-3685-0_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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20
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Ferrand F, Malka D, Bourredjem A, Allonier C, Bouché O, Louafi S, Boige V, Mousseau M, Raoul JL, Bedenne L, Leduc B, Deguiral P, Faron M, Pignon JP, Ducreux M. Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy: results from the multicenter, randomised trial Fédération Francophone de Cancérologie Digestive 9601. Eur J Cancer 2012; 49:90-7. [PMID: 22926014 DOI: 10.1016/j.ejca.2012.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/19/2012] [Accepted: 07/20/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the impact of primary tumour resection on overall survival (OS) of patients diagnosed with stage IV colorectal cancer (CRC). DESIGN Among the 294 patients with non-resectable colorectal metastases enrolled in the Fédération Francophone de Cancérologie Digestive (FFCD) 9601 phase III trial, which compared different first-line single-agent chemotherapy regimens, 216 patients (73%) presented with synchronous metastases at study entry and constituted the present study population. Potential baseline prognostic variables including prior primary tumour resection were assessed by univariate and multivariate Cox analyses. Progression-free survival (PFS) and OS curves were compared with the logrank test. RESULTS Among the 216 patients with stage IV CRC (median follow-up, 33 months), 156 patients (72%) had undergone resection of their primary tumour prior to study entry. The resection and non-resection groups did not differ for baseline characteristics except for primary tumour location (rectum, 14% versus 35%; p=0.0006). In multivariate analysis, resection of the primary was the strongest independent prognostic factor for PFS (hazard ratio (HR), 0.5; 95% confidence interval [CI], 0.4-0.8; p=0.0002) and OS (HR, 0.4; CI, 0.3-0.6; p<0.0001). Both median PFS (5.1 [4.6-5.6] versus 2.9 [2.2-4.1] months; p=0.001) and OS (16.3 [13.7-19.2] versus 9.6 [7.4-12.5]; p<0.0001) were significantly higher in the resection group. These differences in patient survival were maintained after exclusion of patients with rectal primary (n=43). CONCLUSION Resection of the primary tumour may be associated with longer PFS and OS in patients with stage IV CRC starting first-line, single-agent chemotherapy.
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Affiliation(s)
- F Ferrand
- Institut Gustave Roussy, Gastro-intestinal Unit, Department of Oncologic Medicine, Université Paris Sud, Villejuif, France
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Kircher MF, Hricak H, Larson SM. Molecular imaging for personalized cancer care. Mol Oncol 2012; 6:182-95. [PMID: 22469618 PMCID: PMC5528375 DOI: 10.1016/j.molonc.2012.02.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 12/19/2022] Open
Abstract
Molecular imaging is rapidly gaining recognition as a tool with the capacity to improve every facet of cancer care. Molecular imaging in oncology can be defined as in vivo characterization and measurement of the key biomolecules and molecularly based events that are fundamental to the malignant state. This article outlines the basic principles of molecular imaging as applied in oncology with both established and emerging techniques. It provides examples of the advantages that current molecular imaging techniques offer for improving clinical cancer care as well as drug development. It also discusses the importance of molecular imaging for the emerging field of theranostics and offers a vision of how molecular imaging may one day be integrated with other diagnostic techniques to dramatically increase the efficiency and effectiveness of cancer care.
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Affiliation(s)
- Moritz F. Kircher
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
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22
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Høyer M, Erichsen R, Gandrup P, Nørgaard M, Jacobsen JB. Survival in patients with synchronous liver metastases in central and northern Denmark, 1998 to 2009. Clin Epidemiol 2011; 3 Suppl 1:11-7. [PMID: 21814465 PMCID: PMC3144773 DOI: 10.2147/clep.s20613] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE In Denmark, the strategy for treatment of cancer with metastases to the liver has changed dramatically during the period 1998 to 2009, when multidisciplinary care and a number of new treatments were introduced. We therefore examined the changes in survival in Danish patients with colorectal carcinoma (CRC) or other solid tumors (non-CRC) who had liver metastases at time of diagnosis. STUDY DESIGN AND METHODS We included patients diagnosed with liver metastases synchronous with a primary cancer (ie, a solid cancer diagnosed at the same date or within 60 days after liver metastasis diagnosis) during the period 1998 to 2009 identified through the Danish National Registry of Patients. We followed those who survived for more than 60 days in a survival analysis (n = 1021). Survival and mortality rate ratio (MRR) at 1, 3, and 5 years stratified by year of diagnosis were estimated using Cox proportional hazards regression analysis. RESULTS In the total study population of 1021 patients, 541 patients had a primary CRC and 480 patients non-CRC. Overall, the 5-year survival improved from 3% (95% confidence interval [CI]: 1%-6%) in 1998-2000 to 10% (95% CI: 6%-14%) in 2007 to 2009 (predicted value). The 5-year survival for CRC-patients improved from 1% (95% CI: 0%-5%) to 11% (95% CI: 6%-18%) whereas survival for non-CRC patients only increased from 5% (95% CI: 1%-10%) to 8% (95% CI: 4%-14%). CONCLUSION We observed improved survival in patients with liver metastases in a time period characterized by introduction of a structured multidisciplinary care and improved treatment options. The survival gain was most prominent for CRC-patients.
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Affiliation(s)
- Morten Høyer
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Gandrup
- Department of Gastrointestinal Surgery, Aarhus University Hospital, Aalborg, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Bonde Jacobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Yang AD, Brouquet A, Vauthey JN. Extending limits of resection for metastatic colorectal cancer: risk benefit ratio. J Surg Oncol 2010; 102:996-1001. [PMID: 21166004 DOI: 10.1002/jso.21701] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Improvements in treatment strategies and a better knowledge of tumor biology have contributed to an increase in the number of patients with colorectal liver metastases (CLM) who are candidate for surgery. These progresses are on going and the introduction of effective systemic therapy agents contributes further to the increase in the resectability of patients with advanced CLM.
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Affiliation(s)
- Anthony D Yang
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Pessaux P, Marzano E, Casnedi S, Bachellier P, Jaeck D, Chenard MP. Histological and Immediate Postoperative Outcome after Preoperative Cetuximab: Case-Matched Control Study. World J Surg 2010; 34:2765-72. [DOI: 10.1007/s00268-010-0731-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery. Ann Surg 2010; 251:796-803. [PMID: 19858704 DOI: 10.1097/sla.0b013e3181bc9fae] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Aiming at avoidance of futile surgery, we have tested whether radiofrequency ablation (RFA) may be used as first-line treatment in patients with colorectal metastases (CRLM) occurring within the first year after colorectal surgery. SUMMARY BACKGROUND DATA Surgical resection is the standard treatment in patients with CRLM. Major retrospective analyses have identified the interval between colorectal surgery and the occurrence of CRLM to be of prognostic importance. So far, it is unknown whether survival of the respective patients is hampered if RFA is used as first-line treatment. METHODS According to a clinical pathway, we have treated patients with CRLM detected within the first year after colorectal surgery preferentially by RFA (n=28). Resection (n=82) was performed in patients who were deemed not amenable to RFA due to number, size, or location of metastatic lesions. The diameter of lesions differed between the groups. All other characteristics of patients and lesions were comparable. Local recurrence and new hepatic lesions were treated with repeated RFA or surgery whenever possible. RESULTS Local recurrence at the site of ablation or resection occurred in 32% and 4% (P<0.001), new metastases apart from the site of previous treatment in 50% and 34% (P=0.179), and systemic recurrence in 32% and 37% (P=0.820) of the patients after RFA and surgery, respectively. Time to progression was significantly shorter in patients primarily treated with RFA (203 vs. 416 days; P=0.017). After primary treatment, 9 RFA patients and 8 surgery patients were amenable to repeated RFA or repeated surgery resulting in identical rates of disease-free patients and identical 3-year overall survival in both treatment groups: 67% and 60%, respectively; P=0.93. CONCLUSIONS Despite striking differences in local tumor recurrence and shorter time to progression, survival in patients with early CRLM does not depend on the mode of primary hepatic treatment.
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Cresswell AB, Welsh FKS, Rees M. A diagnostic paradigm for resectable liver lesions: to biopsy or not to biopsy? HPB (Oxford) 2009; 11:533-40. [PMID: 20495704 PMCID: PMC2785947 DOI: 10.1111/j.1477-2574.2009.00081.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 04/05/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite a growing body of evidence reporting the deleterious mechanical and oncological complications of biopsy of hepatic malignancy, a small but significant number of patients undergo the procedure prior to specialist surgical referral. Biopsy has been shown to result in poorer longterm survival following resection and advances in modern imaging modalities provide equivalent, or better, diagnostic accuracy. METHODS The literature relating to needle-tract seeding of primary and secondary liver cancers was reviewed. MEDLINE, EMBASE and the Cochrane Library were searched for case reports and series relating to the oncological complications of biopsy of liver malignancies. Current non-invasive diagnostic modalities are reviewed and their diagnostic accuracy presented. RESULTS Biopsy of malignant liver lesions has been shown to result in poorer longterm survival following resection and does not confer any diagnostic advantage over a combination of non-invasive imaging techniques and serum tumour markers. CONCLUSIONS Given that chemotherapeutic advances now often permit downstaging and subsequent resection of 'unresectable' disease, the time has come to abandon biopsy of solid lesions outside the setting of a specialist multi-disciplinary team meeting (MDT).
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Affiliation(s)
- Adrian B Cresswell
- Basingstoke Hepatobiliary Unit, Basingstoke and North Hampshire Hospitals NHS Foundation Trust Basingstoke, UK
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Mailey B, Truong C, Artinyan A, Khalili J, Sanchez-Luege N, Denitz J, Marx H, Wagman LD, Kim J. Surgical resection of primary and metastatic hepatic malignancies following portal vein embolization. J Surg Oncol 2009; 100:184-90. [DOI: 10.1002/jso.21343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zalinski S, Palavecino M, Abdalla EK. Hepatic resection for gastrointestinal stromal tumor liver metastases. Hematol Oncol Clin North Am 2009; 23:115-27, ix. [PMID: 19248975 DOI: 10.1016/j.hoc.2008.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver resection is the preferred treatment for gastrointestinal stromal tumor liver metastases (GIST LMs) when complete resection can be achieved. Major and extended hepatic resections can be safely performed, and using modern techniques, an increasing proportion of patients with GIST LMs are candidates for potentially curative therapy. The combination of tyrosine kinase inhibitor therapy (eg, imatinib) with surgery seems to improve outcome, and although prospective data are lacking, a short neoadjuvant course (6 months) of imatinib therapy followed by resection may improve patient selection for surgery and outcome from treatment. Postoperative therapy with imatinib is generally advised, although the duration of such therapy is not yet clearly defined. These questions may formulate the basis for future prospective studies of imatinib with complete resection of GIST LMs.
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Affiliation(s)
- Stephane Zalinski
- Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA
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Chun YS, Laurent A, Maru D, Vauthey JN. Management of chemotherapy-associated hepatotoxicity in colorectal liver metastases. Lancet Oncol 2009; 10:278-86. [PMID: 19261256 DOI: 10.1016/s1470-2045(09)70064-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Effective systemic drugs are increasingly used to treat patients with colorectal liver metastases. Recent trials have shown that chemotherapy can reduce the size of metastases that are unresectable rendering them resectable, and decrease postoperative recurrence rates in patients with initially resectable tumours. The increasing use of chemotherapy for colorectal liver metastases has raised awareness of the potential hepatotoxicities induced by systemic drugs and the effects of these drugs on outcome after hepatic resection. In this Review, we outline the rationale for the use of perioperative chemotherapy for colorectal liver metastases, associations between specific agents and patterns of liver injury, and strategies to treat patients with suspected or known chemotherapy-associated hepatotoxicity.
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Affiliation(s)
- Yun Shin Chun
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zeh HJ, Brown CK, Holtzman MP, Egorin MJ, Holleran JL, Potter DM, Bartlett DL. A phase I study of hyperthermic isolated hepatic perfusion with oxaliplatin in the treatment of unresectable liver metastases from colorectal cancer. Ann Surg Oncol 2008; 16:385-94. [PMID: 19034580 DOI: 10.1245/s10434-008-0179-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 09/07/2008] [Accepted: 09/08/2008] [Indexed: 12/22/2022]
Abstract
Isolated hepatic perfusion (IHP) is a proven approach for regional delivery of chemotherapy in patients with unresectable primary and metastatic tumors of the liver. Most trials of IHP have utilized melphalan as the active drug in the perfusate. We performed a phase I trial to evaluate the efficacy, safety, and maximum tolerated dose (MTD) of oxaliplatin delivered by hyperthermic isolated hepatic perfusion. A phase I dose-escalation trial of hyperthermic IHP with oxaliplatin in patients with unresectable metastatic colorectal cancer scheduled to undergo placement of a hepatic arterial infusion (HAI) pump was carried out. Thirteen patients were enrolled between November 2003 and September 2006. Dose-limiting veno-occlusive disease was observed at 60 mg/m(2). At the MTD of 40 mg/m(2) only minor transient liver dysfunction was observed. Ultrafilterable platinum area under the curve and maximum concentration delivered by IHP increased nonlinearly with dose as did platinum concentrations in liver biopsies obtained at the end of the 60 min IHP. Seventy-seven percent of patients had a >50% decrease in serum carcinoembryonic antigen (CEA) after IHP. The overall response rate to the combined IHP and HAI therapy was 66%. One patient had a durable complete response (>4 years). We conclude that hyperthermic IHP with oxaliplatin was safe and feasible at a dose of 40 mg/m(2). The ability to obtain complete vascular isolation with open IHP was confirmed. The response rate in this small phase I study was encouraging.
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Affiliation(s)
- Herbert J Zeh
- Department of Surgery, University of Pittsburgh School of Medicine, PA 15232, USA.
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Potentially curable metastatic colorectal cancer. Curr Oncol Rep 2008; 10:225-31. [PMID: 18765153 DOI: 10.1007/s11912-008-0035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although patients with metastatic colorectal cancer have historically had a uniformly dismal prognosis, recent advances in chemotherapeutics and surgical techniques allow many patients to be treated with the potential for long-term survival and cure. Patients with potentially curable disease are those in whom multidisciplinary strategies including surgery can result in safe resection of all metastatic disease with negative margins. Although favorable outcomes using such strategies can increasingly be predicted, the presence of poor prognostic factors does not necessarily represent a contraindication to the use of a potentially curative strategy as long as a margin-negative resection can ultimately be obtained. Further analysis of the innovative strategies and techniques described in this article are needed to maximize cure rates in patients with this disease.
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Garcea G, Ong SL, Maddern GJ. Inoperable colorectal liver metastases: a declining entity? Eur J Cancer 2008; 44:2555-72. [PMID: 18755585 DOI: 10.1016/j.ejca.2008.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Untreated colorectal liver metastases (CLMs) have a dismal prognosis. Surgery remains the gold standard of treatment, but many patients will have inoperable disease at presentation. Until recently, the outlook for such patients was bleak. The purpose of this review was to report on available options in the treatment CLMs, which would be considered unresectable by conventional evaluation. METHODS Inclusion criteria were articles published in English-language journals reporting on either retrospective or prospective cohorts of patients undergoing treatment for conventionally inoperable CLM. Main outcome measures were survival, resectability rates, morbidity and mortality following treatment of the patients' disease. RESULTS Improved chemotherapy regimes and other innovative treatments have opened up new options for such patients and may even render conventionally inoperable disease resectable. The aim of treatment should be down-staging of metastases to achieve resectability, however, other treatments such as ablation may be also be used (either alone or in conjunction with resection). CONCLUSION A nihilistic attitude to the patient with seemingly inoperable liver metastases should be discouraged. Discussion of such patients at multi-disciplinary meetings is essential in order to plan and monitor treatments.
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Affiliation(s)
- G Garcea
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
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