Perioperative therapy in metastatic colorectal cancer: Pattern of use and survival outcomes.
metastatic colorectal cancer
perioperative therapy
resection
survival outcomes
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
06
09
2020
revised:
09
10
2020
accepted:
12
10
2020
pubmed:
31
10
2020
medline:
5
3
2021
entrez:
30
10
2020
Statut:
ppublish
Résumé
Multimodality therapy of metastatic colorectal cancer (mCRC) is currently considered the standard of care. The aim of this study was to evaluate the impact of perioperative therapy on surgical resection in mCRC. The National Cancer Database was analyzed for affected patients between 2004 and 2013. Univariate and multivariate analyses were done to identify factors associated with patient outcomes. Kaplan-Meier analysis and Cox proportional hazards models were used for the association between patient characteristics and survival. About 61,940 patients with mCRC were identified. Mean age = 63.4 years (SD ± 14). About 69% had a colon primary and 32% had only one metastatic site. Only 49% of those who underwent surgery for both primary and metastatic sites received postoperative chemotherapy (p < .001). Negative prognostic factors included no chemotherapy received (hazard ratio [HR], 2.32; 2.27-2.37; p < .001), more than three metastatic sites (HR, 2.28; 2.09-2.48; p < .001), year of diagnosis between 2004 and 2008 (HR, 1.71; 1.15-1.20; p < .001) and colon tumor location with right worse than left-sided (HR, 1.21; 1.19-1.24; p < .001). Five-year overall survival for resection of the primary and metastatic site (28.2%) was higher than for no surgical treatment (4.7%). Perioperative therapy was associated with improved survival, following resection of metastatic sites or primary tumor.
Sections du résumé
BACKGROUND
BACKGROUND
Multimodality therapy of metastatic colorectal cancer (mCRC) is currently considered the standard of care. The aim of this study was to evaluate the impact of perioperative therapy on surgical resection in mCRC.
METHODS
METHODS
The National Cancer Database was analyzed for affected patients between 2004 and 2013. Univariate and multivariate analyses were done to identify factors associated with patient outcomes. Kaplan-Meier analysis and Cox proportional hazards models were used for the association between patient characteristics and survival.
RESULTS
RESULTS
About 61,940 patients with mCRC were identified. Mean age = 63.4 years (SD ± 14). About 69% had a colon primary and 32% had only one metastatic site. Only 49% of those who underwent surgery for both primary and metastatic sites received postoperative chemotherapy (p < .001). Negative prognostic factors included no chemotherapy received (hazard ratio [HR], 2.32; 2.27-2.37; p < .001), more than three metastatic sites (HR, 2.28; 2.09-2.48; p < .001), year of diagnosis between 2004 and 2008 (HR, 1.71; 1.15-1.20; p < .001) and colon tumor location with right worse than left-sided (HR, 1.21; 1.19-1.24; p < .001). Five-year overall survival for resection of the primary and metastatic site (28.2%) was higher than for no surgical treatment (4.7%).
CONCLUSION
CONCLUSIONS
Perioperative therapy was associated with improved survival, following resection of metastatic sites or primary tumor.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
596-605Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Rahman R, Schmaltz C, Jackson CS, Simoes EJ, Jackson-Thompson J, Ibdah JA. Increased risk for colorectal cancer under age 50 in racial and ethnic minorities living in the United States. Cancer Med. 2015;4(12):1863-1870.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34.
Cronin KA, Lake AJ, Scott S, et al. Annual report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer. 2018;124(13):2785-2800.
Amri R, Bordeianou LG, Sylla P, Berger DL. Impact of screening colonoscopy on outcomes in colon cancer surgery. JAMA Surg. 2013;148(8):747-754.
Lee WS, Yun SH, Chun HK, et al. Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Colorectal Dis. 2007;22(6):699-704.
Yoo PS, Lopez-Soler RI, Longo WE, Cha CH. Liver resection for metastatic colorectal cancer in the age of neoadjuvant chemotherapy and bevacizumab. Clin Colorectal Cancer. 2006;6(3):202-207.
Qiu M, Hu J, Yang D, Cosgrove DP, Xu R. Pattern of distant metastases in colorectal cancer: a SEER based study. Oncotarget. 2015;6(36):38658-38666.
Luo D, Liu Q, Yu W, et al. Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study. Int J Colorectal Dis. 2018;33:1241-1249.
Ciardiello D, Vitiello PP, Cardone C, et al. Immunotherapy of colorectal cancer: challenges for therapeutic efficacy. Cancer Treat Rev. 2019;76:22-32.
Overman MJ, Lonardi S, Wong KYM, et al. Durable clinical benefit with nivolumab plus ipilimumab in DNA mismatch repair-deficient/microsatellite instability-high metastatic colorectal cancer. J Clin Oncol. 2018;36(8):773-779.
Saito Y, Omiya H, Kohno K, et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg. 2002;124(5):1007-1013.
Rees M, Tekkis PP, Welsh FK, O'Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247(1):125-135.
Gulack BC, Nussbaum DP, Keenan JE, et al. Surgical resection of the primary tumor in stage iv colorectal cancer without metastasectomy is associated with improved overall survival compared with chemotherapy/radiation therapy alone. Dis Colon Rectum. 2016;59(4):299-305.
Sievers CK, Kratz JD, Zurbriggen LD, et al. The multidisciplinary management of colorectal cancer: present and future paradigms. Clin Colon Rectal Surg. 2016;29(3):232-238.
Tarantino I, Warschkow R, Worni M, et al. Prognostic relevance of palliative primary tumor removal in 37,793 metastatic colorectal cancer patients: a population-based, propensity score-adjusted trend analysis. Ann Surg. 2015;262(1):112-120.
Ruo L, Gougoutas C, Paty PB, Guillem JG, Cohen AM, Wong WD. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg. 2003;196(5):722-728.
Gresham G, Renouf DJ, Chan M, et al. Association between palliative resection of the primary tumor and overall survival in a population-based cohort of metastatic colorectal cancer patients. Ann Surg Oncol. 2014;21(12):3917-3923.
Karoui M, Roudot-Thoraval F, Mesli F, et al. Primary colectomy in patients with stage IV colon cancer and unresectable distant metastases improves overall survival: results of a multicentric study. Dis Colon Rectum. 2011;54(8):930-938.
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(3):255-263.
Alawadi Z, Phatak UR, Hu CY, et al. Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer. Cancer. 2017;123(7):1124-1133.
Liu YDN, Nickleach DC, Zhang C, Switchenko JM, Kowalski J. Carry out streamlined routine data analyses with reports for observational studies: introduction to a series of generic SAS® macros. F1000 Res. 2018;7:1955.
Kemeny N. Management of liver metastases from colorectal cancer. Oncology. 2006;20(10):1161-1176.
Kobayashi H, Mochizuki H, Sugihara K, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery. 2007;141(1):67-75.
Singh S, Singh PP, Murad MH, Singh H, Samadder NJ. Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1375-1389.
Van Cutsem E, Nordlinger B, Adam R, et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer. 2006;42(14):2212-2221.
Miyamoto Y, Beppu T, Sakamoto Y, et al. Simultaneous laparoscopic resection of primary tumor and liver metastases for colorectal cancer: surgical technique and short-term outcome. Hepatogastroenterology. 2015;62(140):846-852.
Miyoshi N, Ohue M, Shingai T, et al. Clinicopathological characteristics and prognosis of stage IV colorectal cancer. Mol Clin Oncol. 2015;3(5):1093-1098.
Khattak MA, Martin HL, Beeke C, et al. Survival differences in patients with metastatic colorectal cancer and with single site metastatic disease at initial presentation: results from South Australian clinical registry for advanced colorectal cancer. Clin Colorectal Cancer. 2012;11(4):247-54.
Tie J, Lipton L, Desai J, et al. KRAS mutation is associated with lung metastasis in patients with curatively resected colorectal cancer. Clin Cancer Res. 2011;17(5):1122-1130.
Taylor A, Primrose A, Langeberg W, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;4:283-301.
Pulitanò C, Bodingbauer M, Aldrighetti L, et al. Liver resection for colorectal metastases in presence of extrahepatic disease: results from an international multi-institutional analysis. Ann Surg Oncol. 2011;18(5):1380-1388.
Onesti JK, Mascarenhas CR, Chung MH, Davis AT. Isolated metastasis of colon cancer to the scapula: is surgical resection warranted? World J Surg Oncol. 2011;9:137.
Kruser TJ, Chao ST, Elson P, et al. Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer. 2008;113(1):158-165.
Katoh M, Unakami M, Hara M, Fukuchi S. Bone metastasis from colorectal cancer in autopsy cases. J Gastroenterol. 1995;30(5):615-618.
Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK. The characteristics of bone metastasis in patients with colorectal cancer: a long-term report from a single institution. World J Surg. 2016;40(4):982-986.
Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002;94(10):2698-2705.
Ko FC, Liu JM, Chen WS, Chiang JK, Lin TC, Lin JK. Risk and patterns of brain metastases in colorectal cancer: 27-year experience. Dis Colon Rectum. 1999;42(11):1467-1471.
Lee DY, Teng A, Pedersen RC, et al. Racial and socioeconomic treatment disparities in adolescents and young adults with stage II-III rectal cancer. Ann Surg Oncol. 2017;24(2):311-318.