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Jin X, Wu Y, Feng Y, Lin Z, Zhang N, Yu B, Mao A, Zhang T, Zhu W, Wang L. A population-based predictive model identifying optimal candidates for primary and metastasis resection in patients with colorectal cancer with liver metastatic. Front Oncol 2022; 12:899659. [PMID: 36276059 PMCID: PMC9585382 DOI: 10.3389/fonc.2022.899659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/13/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The survival benefit of primary and metastatic resection for patients with colorectal cancer with liver metastasis (CRLM) has been observed, but methods for discriminating which individuals would benefit from surgery have been poorly defined. Herein, a predictive model was developed to stratify patients into sub-population based on their response to surgery. METHODS We assessed the survival benefits for adults diagnosed with colorectal liver metastasis by comparing patients with curative surgery vs. those without surgery. CRLM patients enrolled in the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 were identified for model construction. Other data including CRLM patients from our center were obtained for external validation. Calibration plots, the area under the curve (AUC), and decision curve analysis (DCA) were used to evaluate the performance of the nomogram compared with the tumor-node-metastasis (TNM) classification. The Kaplan-Meier analysis was performed to examine whether this model would distinguish patients who could benefit from surgery. RESULTS A total of 1,220 eligible patients were identified, and 881 (72.2%) underwent colorectal and liver resection. Cancer-specific survival (CSS) for the surgery group was significantly better than that for the no-surgery group (41 vs. 14 months, p < 0.001). Five factors were found associated with CSS and adopted to build the nomograms, i.e., age, T stage, N stage, neoadjuvant chemotherapy, and primary tumor position. The AUC of the CRLM nomogram showed a better performance in identifying patients who could obtain benefits in the surgical treatment, compared with TNM classification (training set, 0.826 [95% CI, 0.786-0.866] vs. 0.649 [95% CI, 0.598-0.701]; internal validation set, 0.820 [95% CI, 0.741-0.899] vs. 0.635 [95% CI, 0.539-0.731]; external validation set, 0.763 [95% CI, 0.691-0.836] vs. 0.626 [95% CI, 0.542-0.710]). The calibration curves revealed excellent agreement between the predicted and actual survival outcomes. The DCA showed that the nomogram exhibited more clinical benefits than the TNM staging system. The beneficial and surgery group survived longer significantly than the non-beneficial and surgery group (HR = 0.21, 95% CI, 0.17-0.27, p < 0.001), but no difference was observed between the non-beneficial and surgery and non-surgery groups (HR = 0.89, 95% CI, 0.71-1.13, p = 0.344). CONCLUSIONS An accurate and easy-to-use CRLM nomogram has been developed and can be applied to identify optimal candidates for the resection of primary and metastatic lesions among CRLM patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Weiping Zhu
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lu Wang
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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Zhang H, Jin Y, Huang R, Wang G. Minimally Invasive Concepts in Treating Synchronous Liver Metastases Rectal Cancer Patients: Six Cases Report. J INVEST SURG 2022; 35:1700-1703. [PMID: 35815462 DOI: 10.1080/08941939.2022.2088905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Rectal cancer patients with synchronous liver metastases (SLM) is common in clinical practice. However, the application of conventional natural orifice specimen extraction surgery (NOSES) and NOSES with specimen extraction via stoma/hepatectomy incision in the special population is rarely explored. CASE REPORT Six SLM rectal cancer patients were treated with simultaneous surgical resection and the specimens were extracted via anal/stoma/hepatectomy incision. Respectively, intraoperative and postoperative data, anal function 3 months after surgery and long-term prognosis were reviewed. RESULTS Intraoperative and postoperative data and anal function were reliable for the six cases. Only one patient died of brain and bone metastases at 84 months after surgery and the other five patients were alive at their last follow-up. CONCLUSIONS Simultaneous surgical resection with the concept of conventional NOSES and NOSES with specimen extraction via stoma/hepatectomy incision is safety for SLM rectal patients.
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Affiliation(s)
- Hao Zhang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yinghu Jin
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Rui Huang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guiyu Wang
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Wu Q, Wang WJ, Huang YQ, Fang SY, Guan YJ. Nomograms for estimating survival in patients with liver-only colorectal metastases: A retrospective study. Int J Surg 2018; 60:1-8. [PMID: 30366096 DOI: 10.1016/j.ijsu.2018.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to develop and validate nomograms for individual risk prediction in patients with liver-only colorectal metastases (CRLM). METHODS Histologically confirmed CRLM diagnosed between 2010 and 2015 were analysed from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were used to obtain independent prognostic factors to build nomograms for predicting 1- and 3-year overall survival (OS) and cancer-specific survival (CSS). The predictive accuracy of the nomogram was determined by concordance index (C-index) and calibration plots. RESULTS A total of 9615 patients with CRLM were included in the study. A nomogram predicting OS was constructed according to 9 independent clinicopathological factors. A nomogram predicting CSS was constructed based on the same 9 factors. The C-indexes of the nomograms were significantly better than the TNM staging system (7th edition) in both sets for predicting both OS and CSS. The calibration plots displayed an optimal agreement between the predictive results and the actual observed outcomes. CONCLUSIONS The proposed nomograms can help clinicians calculate the probability in patients with CRLM.
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Affiliation(s)
- Qiong Wu
- Department of Intervention and Vascular Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Suzhou, Jiangsu, 215001, China
| | - Wen-Jie Wang
- Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Suzhou, Jiangsu, 215001, China
| | - Yue-Qing Huang
- Department of General Practice, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Suzhou, Jiangsu, 215001, China
| | - Shi-Ying Fang
- Department of General Surgery, West Anhui Health Vocational College, Luan, Anhui, 237000, China
| | - Yong-Jun Guan
- Department of General Surgery, Yan Da International Hospital, Langfang, Hebei, 065000, China.
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Coimbra FJF, Ribeiro HSDC, Marques MC, Herman P, Chojniak R, Kalil AN, Wiermann EG, Cavallero SRDA, Coelho FF, Fernandes PHDS, Silvestrini AA, Almeida MFA, de Araújo ALE, Pitombo M, Teixeira HM, Waechter FL, Ferreira FG, Diniz AL, D'Ippolito G, D'Ippolito G, Begnami MDFDS, Prolla G, Balzan SMP, de Oliveira TB, Szultan LA, Lendoire J, Torres OJM. FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:222-30. [PMID: 26734788 PMCID: PMC4755170 DOI: 10.1590/s0102-6720201500040002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
Background : Liver metastases of colorectal cancer are frequent and potentially fatal event
in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized
epidemiological data and results of the various treatment modalities established.
Method: Was realized deep discussion on detecting and staging metastatic colorectal
cancer, as well as employment of imaging methods in the evaluation of response to
instituted systemic therapy. Results : The next step was based on the definition of which patients would have their
metastases considered resectable and how to expand the amount of patients elegible
for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors,
validated to be taken into account in clinical practice.
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Affiliation(s)
| | | | | | - Paulo Herman
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | - Rubens Chojniak
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Marcos Pitombo
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
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Lupinacci RM, Agostini J, Chirica M, Balladur P, Chafaï N, Parc Y, Tiret E, Paye F. Combined stoma reversal and liver resection: a matched case–control study. Am J Surg 2015; 210:501-5. [DOI: 10.1016/j.amjsurg.2015.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/15/2015] [Accepted: 03/29/2015] [Indexed: 01/29/2023]
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Fontana R, Herman P, Hermam P, Pugliese V, Perini MV, Coelho FF, Velho FF, Cecconello I. Surgical outcomes and prognostic factors in patients with synchronous colorectal liver metastases. ARQUIVOS DE GASTROENTEROLOGIA 2014; 51:4-9. [PMID: 24760056 DOI: 10.1590/s0004-28032014000100002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/25/2013] [Indexed: 02/06/2023]
Abstract
CONTEXT Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. METHODS Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. RESULTS Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥ 50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. CONCLUSIONS Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%.
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Affiliation(s)
- Rafael Fontana
- Universidade de Caxias do Sul, Faculdade de Medicina, Caxias do Sul, RS, Brasil
| | | | - Paulo Hermam
- Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil
| | - Vincenzo Pugliese
- Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil
| | - Marcos Vinicius Perini
- Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil
| | | | - Fabricio Ferreira Velho
- Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil
| | - Ivan Cecconello
- Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil
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