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Schell F, Kefleyesus A, Benzerdjeb N, Passot G, Rousset P, Omar A, Villeneuve L, Péron J, Glehen O, Kepenekian V. Influence of Extraperitoneal Metastases on the Curative-Intent Management of Colorectal Peritoneal Metastases. Ann Surg Oncol 2023. [PMID: 36864324 DOI: 10.1245/s10434-023-13279-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Selected patients with colorectal cancer peritoneal metastasis (CRPM) and extraperitoneal disease could be treated radically with a multimodal approach combining complete cytoreductive surgery, thermoablation, radiotherapy, and systemic and intraperitoneal chemotherapy. The impact of extraperitoneal metastatic sites (EPMS) in this setting remains unclear. PATIENTS AND METHODS Patients with CRPM undergoing complete cytoreduction in 2005-2018 were grouped in: peritoneal disease only (PDO), one EPMS (1 + EPMS), two or more EPMS (2 + EPMS). A retrospective analysis compared overall survival (OS) and postoperative outcomes. RESULTS Of 433 patients, 109 had 1 + EPMS and 31 had 2 + EPMS. Overall, 101 patients had liver metastasis, 19 lung metastasis, and 30 retroperitoneal lymph node (RLN) invasion. The median OS was 56.9 months. There was no significant OS difference between PDO and 1 + EPMS groups (64.6 and 57.9 months, respectively), whereas OS was lower in the 2 + EPMS group (29.4 months, p = 0.005). In multivariate analysis, 2 + EPMS [hazard ratio (HR) 2.86, 95% confidence interval (CI) 1.33-6.12, p = 0.007], Sugarbaker's Peritoneal Carcinomatosis Index (PCI) > 15 (HR 3.86, 95% CI 2.04-7.32, p < 0.001), poorly differentiated tumors (HR 2.62, 95% CI 1.21-5.66, p = 0.015), and BRAF mutation (HR 2.10, 95% CI 1.11-3.99, p = 0.024) were independent poor prognostic factors, while adjuvant chemotherapy was beneficial (HR 0.33, 95% CI 0.20-0.56, p < 0.001). Patients with liver resection did not show higher severe complication rates. CONCLUSION In patients with CRPM selected for a radical surgical approach, limited extraperitoneal disease involving one site, notably the liver, does not seem to significantly impair postoperative results. RLN invasion appeared as a poor prognostic factor in this population.
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Affiliation(s)
- Frédéric Schell
- Surgical Oncology Department, Hôpital Lyon Sud - Service de Chirurgie Digestive et Oncologique, Hospices Civils de Lyon, 165 Rue du Grand Revoyet, 69310, Pierre-Bénite, France.,EA3738 CICLY, Université Claude Bernard Lyon 1 (UVBL1), Lyon, France
| | - Amaniel Kefleyesus
- Surgical Oncology Department, Hôpital Lyon Sud - Service de Chirurgie Digestive et Oncologique, Hospices Civils de Lyon, 165 Rue du Grand Revoyet, 69310, Pierre-Bénite, France.,Department of Visceral Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nazim Benzerdjeb
- EA3738 CICLY, Université Claude Bernard Lyon 1 (UVBL1), Lyon, France.,Department of Pathology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Guillaume Passot
- Surgical Oncology Department, Hôpital Lyon Sud - Service de Chirurgie Digestive et Oncologique, Hospices Civils de Lyon, 165 Rue du Grand Revoyet, 69310, Pierre-Bénite, France.,EA3738 CICLY, Université Claude Bernard Lyon 1 (UVBL1), Lyon, France
| | - Pascal Rousset
- EA3738 CICLY, Université Claude Bernard Lyon 1 (UVBL1), Lyon, France.,Department of Radiology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Alhadeedi Omar
- Surgical Oncology Department, Hôpital Lyon Sud - Service de Chirurgie Digestive et Oncologique, Hospices Civils de Lyon, 165 Rue du Grand Revoyet, 69310, Pierre-Bénite, France.,EA3738 CICLY, Université Claude Bernard Lyon 1 (UVBL1), Lyon, France
| | | | - Julien Péron
- Medical Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Lyon, France
| | - Olivier Glehen
- Surgical Oncology Department, Hôpital Lyon Sud - Service de Chirurgie Digestive et Oncologique, Hospices Civils de Lyon, 165 Rue du Grand Revoyet, 69310, Pierre-Bénite, France.,EA3738 CICLY, Université Claude Bernard Lyon 1 (UVBL1), Lyon, France
| | - Vahan Kepenekian
- Surgical Oncology Department, Hôpital Lyon Sud - Service de Chirurgie Digestive et Oncologique, Hospices Civils de Lyon, 165 Rue du Grand Revoyet, 69310, Pierre-Bénite, France. .,EA3738 CICLY, Université Claude Bernard Lyon 1 (UVBL1), Lyon, France.
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Antiangiogenic Drug-Induced Proteinuria as a Prognostic Factor in Metastatic Colorectal Cancer. Curr Oncol 2022; 29:3996-4011. [PMID: 35735428 PMCID: PMC9221669 DOI: 10.3390/curroncol29060319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022] Open
Abstract
Treatment with bevacizumab is known to cause adverse events such as proteinuria and hypertension, amongst others. However, while bevacizumab-induced hypertension has been linked to increased overall survival (OS), data on proteinuria are controversial. We performed a retrospective analysis to observe the influence of adverse events developed during treatment with bevacizumab and chemotherapy on the OS in patients with metastatic colorectal cancer (mCRC). Kaplan–Meier and log-rank analyses were used to assess differences in OS, and hazard ratios (HR) were estimated using Cox models. Out of the 3497 mCRC patients admitted to our center between 2014 and 2019, 150 met the criteria for inclusion in our analysis. Out of these, 50.7% experienced proteinuria and had reached a longer OS (40 versus 25 months, p = 0.015) and progression-free survival (15 versus 12 months, p = 0.039). The following groups were identified as having a lower risk of death: patients with proteinuria (HR 0.589; 95% CI 0.402–0.863; p = 0.007), one metastatic site (HR 0.533; 95% CI 0.363–0.783; p = 0.001), and non-metastatic stage at diagnosis (HR 0.459; 95% CI 0.293–0.720; p = 0.001). Patients with anemia and diabetes had an increased risk of death. Proteinuria emerges as a useful prognostic factor in mCRC patients undergoing bevacizumab-based systemic therapy, and it could be easily integrated into the decision-making process, thus allowing physicians to further individualize systemic treatments.
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Liu Y, Chi S, Zhou X, Zhao R, Xiao C, Wang H. Prognostic value of distant metastatic sites in stage IV endometrial cancer: A SEER database study of 2948 women. Int J Gynaecol Obstet 2020; 149:16-23. [PMID: 31833058 DOI: 10.1002/ijgo.13084] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/18/2019] [Accepted: 12/10/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the prognosis of women with distant metastasis at the time of endometrial cancer (EC) diagnosis and identify prognostic factors according to metastatic site. METHODS A retrospective cohort study of women diagnosed with EC according to the SEER database between 2010 and 2014. Univariate and multivariate Cox regression was used to identify variables associated with overall survival. Kaplan-Meier curves were used to compare survival among different groups. RESULTS Overall, 2948 women with stage IV EC were identified. The most common distant metastatic site was the lung. Having a distant metastatic site independently predicted overall survival. Using brain metastasis as a reference, overall survival was longer for liver (P=0.049), lung (P=0.005), and bone (P=0.019) metastasis. Relative to no distant metastasis, overall survival was shorter for women with one (P<0.001) or two or more (P<0.001) sites of distant metastasis. Overall survival was independently influenced by tumor grade, insurance status, and surgery among women with only lung metastasis. CONCLUSION The findings showed that the prognosis of women with stage IV EC differs by distant metastatic site, and identified several predictors of poor survival. They may help clinicians to better predict prognosis for newly diagnosed cases of EC with distant metastasis.
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Affiliation(s)
- Yan Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuqi Chi
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zhou
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengyu Xiao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yoon MS, Huh SJ, Kim HJ, Kim YS, Kim YB, Kim JY, Lee JH, Kim HJ, Cha J, Kim JH, Kim J, Yoon WS, Choi JH, Chun M, Choi Y, Lee KK, Kim M, Jeong JU, Chang SK, Park W. Adjuvant Treatment after Surgery in Stage IIIA Endometrial Adenocarcinoma. Cancer Res Treat 2015; 48:1074-83. [PMID: 26511800 PMCID: PMC4946370 DOI: 10.4143/crt.2015.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/07/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. MATERIALS AND METHODS A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancertreated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed. RESULTS Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively). CONCLUSION We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.
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Affiliation(s)
- Mee Sun Yoon
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Seung Jae Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Joo-Young Kim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jong-Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hun Jung Kim
- Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea
| | - Jihye Cha
- Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Juree Kim
- Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Won Sup Yoon
- Department of Radiation Oncology Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Youngmin Choi
- Department of Radiation Oncology, Dong-A University School of Medicine, Busan, Korea
| | - Kang Kyoo Lee
- Department of Radiation Oncology, University of Wonkwang School of Medicine, Iksan, Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sei Kyung Chang
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Outcome of Endometrial Cancer Stage IIIA with Adnexa or Serosal Involvement Only. Obstet Gynecol Int 2011; 2011:962518. [PMID: 21765840 PMCID: PMC3135161 DOI: 10.1155/2011/962518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/07/2011] [Accepted: 02/18/2011] [Indexed: 11/18/2022] Open
Abstract
Objective. The aim of this study is to look at possible differences in outcome between serosa and adnexal involvement stage IIIA endometrial carcinoma. Methods. 67 patients with stage IIIA endometrial carcinoma were included, 46 with adnexal involvement and 21 with serosa. A central histopathological review was performed. Results. The 7-year locoregional failure rate was (LRFR) 2.2% for adnexal involvement and 16.0% for involvement of the serosa (P = .0522). The 7-year distant metastasis-free survival was 72.7% for adnexal involvement and 58.7% for serosa (P = .3994). The 7-year disease-specific survival (DSS) was 71.8% for patients with adnexal involvement and 75.4% for patients with serosa. Conclusion. Endometrial carcinoma stage IIIA with involvement of the adnexa or serosa showed to have a comparable disease-specific survival. Locoregional control was worse for serosa involvement compared to adnexa.
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Geller MA, Ivy JJ, Ghebre R, Downs LS, Judson PL, Carson LF, Jonson AL, Dusenbery K, Vogel RI, Boente MP, Argenta PA. A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a "Sandwich" method for stage III, IV, and recurrent endometrial cancer. Gynecol Oncol 2011; 121:112-7. [PMID: 21239048 DOI: 10.1016/j.ygyno.2010.12.338] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by pelvic radiotherapy and then consolidation chemotherapy in patients with advanced or recurrent endometrial cancer. METHODS Patients with surgically staged III-IV (excluding IIIA from positive cytology alone) endometrial cancer or biopsy confirmed recurrent disease were eligible. Treatment consisted of 3 cycles of docetaxel (75 mg/m²) and carboplatin (AUC 6) on a q21 day schedule followed by involved field irradiation (45 Gy)± brachytherapy and three additional cycles of docetaxel and carboplatin. Kaplan-Meier (KM) methods estimated overall survival (OS) and progression free survival (PFS). RESULTS Forty-two patients enrolled, 7 did not complete therapy. 95% (39/41) had primary disease. Median age=58 years (range: 21-81 years). 78% (32/41)=endometrioid histology. Stages=10 IIIA, 21 IIIC, 1 IVA, 7 IVB, (recurrent=1 IC, 1 IIA). There were 23 non-hematologic and 14 grade 3 and 16 grade 4 hematologic toxicities. Seven patients died following treatment with a median follow-up of 28 months (range: 7-70 months). KM estimates and 95% confidence intervals for OS at 1 year were 95% (82-99%), at 3 years 90% (75-96%), and at 5 years 71% (45-86%). Of the 39 with primary disease, 11 progressed or died within 5 years of study enrollment. KM estimates and 95% confidence intervals for PFS at 1 year were 87% (72-94%), at 3 years 71% (51-83%), and at 5 years 64% (42-80%). CONCLUSIONS "Sandwiching" radiation between chemotherapy for advanced or recurrent endometrial cancer merits further development based on the reported PFS and OS.
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Affiliation(s)
- Melissa A Geller
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
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