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Zurlo IV, Calegari MA, Congedo MT, Basso M, Vita ML, Petracca Ciavarella L, Vivolo R, Anghelone A, Pozzo C, Salvatore L, Meacci E, Margaritora S, Tortora G. A Retrospective Analysis of Real-Life Management of Colorectal Cancer Lung-Limited Metastases Treated with Surgery: Outcomes and Prognostic Factors. J Clin Med 2024; 13:6651. [PMID: 39597795 PMCID: PMC11594730 DOI: 10.3390/jcm13226651] [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: 07/14/2024] [Revised: 11/02/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024] Open
Abstract
Background: Unlike liver metastases, the role of surgery in colorectal cancer lung-limited metastases (CCLLM) is not yet established, and data are still poor. We performed a retrospective analysis to evaluate the impact of surgery on the management of CCLLM. Material and Method: We retrospectively analyzed patients who received surgery for CCLLM at our Institution from January 2010 to June 2019. The aim of the study was to evaluate the impact of clinical and pathological features on the survival (OS and DFS) of patients treated with surgery for CCLLM. Results: One hundred and fifty patients were included in the analysis. Seventy-six patients received preoperative chemotherapy (pCT) and 56 an adjuvant treatment (aCT), while 18 underwent up-front surgery without CT. In the whole population, median OS (mOS) and median DFS (mDFS) were 54.1 months (95%CI 44.0-82.1) and 24.0 months (95%CI 20.0-31.2), respectively. In multivariate analysis, number of metastases was the only factor correlated to DFS (p = 0.0006) and OS (p = 0.0018). Conclusion: Our study, although retrospective and of small size, shows that tumor burden (number of metastases) is the main prognostic factor in patients undergoing lung surgery for CCLLM. Moreover, our results suggest that surgery for lung metastases might prolong survival. These data strengthen the role of multidisciplinary management to allow patients with CCLLM to pursue local treatment whenever possible, even regardless of previous liver surgery or RAS mutated status.
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Affiliation(s)
- Ina Valeria Zurlo
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
- Oncologia Medica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Alessandra Calegari
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
| | - Maria Teresa Congedo
- Unità di Chirurgia Toracica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, 00168 Rome, Italy; (M.T.C.); (M.L.V.); (L.P.C.); (E.M.); (S.M.)
| | - Michele Basso
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
| | - Maria Letizia Vita
- Unità di Chirurgia Toracica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, 00168 Rome, Italy; (M.T.C.); (M.L.V.); (L.P.C.); (E.M.); (S.M.)
| | - Leonardo Petracca Ciavarella
- Unità di Chirurgia Toracica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, 00168 Rome, Italy; (M.T.C.); (M.L.V.); (L.P.C.); (E.M.); (S.M.)
| | - Raffaella Vivolo
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
| | - Annunziato Anghelone
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
| | - Carmelo Pozzo
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
| | - Lisa Salvatore
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
- Oncologia Medica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elisa Meacci
- Unità di Chirurgia Toracica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, 00168 Rome, Italy; (M.T.C.); (M.L.V.); (L.P.C.); (E.M.); (S.M.)
- Unità di Chirurgia Toracica, Università Cattolica del Sacro Cuore—IRCCS, 00168 Rome, Italy
| | - Stefano Margaritora
- Unità di Chirurgia Toracica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, 00168 Rome, Italy; (M.T.C.); (M.L.V.); (L.P.C.); (E.M.); (S.M.)
- Unità di Chirurgia Toracica, Università Cattolica del Sacro Cuore—IRCCS, 00168 Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Fondazione Policlinico Universitario “A Gemelli”—IRCCS, Largo Francesco Vito n 1, 00168 Rome, Italy; (M.A.C.); (M.B.); (R.V.); (A.A.); (C.P.); (L.S.); (G.T.)
- Oncologia Medica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Mahuron KM, Hernandez MC, Wong P, Fan D, Ituarte PHG, Raoof M, Singh G, Fong Y, Melstrom LG. Liver Resection With Extrahepatic Disease: A Population-Based Analysis of Thoughtful Selection. J Surg Oncol 2024. [PMID: 39466980 DOI: 10.1002/jso.27944] [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: 09/12/2024] [Accepted: 09/18/2024] [Indexed: 10/30/2024]
Abstract
BACKGROUND The oncologic benefit of liver resection for colorectal liver metastases (CRLM) in the setting of concurrent extrahepatic disease (EHD) is controversial. We performed a population-based, cross-sectional study to determine the practice patterns and overall survival (OS) of patients with CRLM + EHD who underwent liver resection. METHODS Patients with CRLM + EHD were identified using the California Cancer Registry from 2000 to 2019. Records were linked to the Office of Statewide Health Planning Inpatient Database. Patient demographics, clinical characteristics, and survival were compared between CRLM + EHD patients with and without liver resection. RESULTS Of 170 978 patients with CRLM, 62 003 (36%) had concurrent EHD (CRLM + EHD). In all, 3736 (6%) of CRLM + EHD underwent liver resection compared to 22% of patients with liver limited CRLM. Compared to CRLM + EHD without liver resection, CRLM + EHD with resection were younger, had fewer comorbidities, received higher frequencies of perioperative chemotherapy, and were more likely to have only a single site of EHD rather than multiple sites. Median OS was significantly higher for CRLM + EHD with resection compared to without (52 vs. 27 months, HR 0.46 [95% CI 0.44-0.47], p < 0.001). Regarding the location of EHD, this survival benefit was observed with liver resection for lung, peritoneal, intraabdominal lymph nodes, ovarian, and bone metastases. CONCLUSIONS In a large population-based setting, subsets of CRLM + EHD patients that undergo liver resection are associated with prolonged survival. These results support surgery with thoughtful patient selection to optimize survival outcomes in this population.
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Affiliation(s)
- Kelly M Mahuron
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Matthew C Hernandez
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Paul Wong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Darrell Fan
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Philip H G Ituarte
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Mustafa Raoof
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Gagandeep Singh
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Laleh G Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
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Yang ST, Chang WH, Chou FW, Liu HH, Lee WL, Wang PH. Front-line chemoimmunotherapy for treating epithelial ovarian cancer: Part II promising results of phase 2 study of paclitaxel-carboplatin-oregovomab regimen. Taiwan J Obstet Gynecol 2024; 63:10-16. [PMID: 38216242 DOI: 10.1016/j.tjog.2023.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/14/2024] Open
Abstract
In the Part I, we have discussed the background of CA125 and the development of anti-CA125 monoclonal antibody (MAb) to highlight the potential role of CA125 and anti-CA125 MAb in the management of women with advanced stage epithelial ovarian cancer (EOC). Glycosylation change either by N-link or by O-link of CA125 is supposed to play a role in the modification of immunity. Anti-CA125 MAb, which can be classified as OC 125-like Abs, M11-like Abs, and OV197-like Abs, is often used for diagnosing, screening, monitoring and detecting the mesothelin-related diseases of the abdominal cavity, particular for those women with EOC. Additionally, anti-CA125 MAb also plays a therapeutic role, named as OvaRex MAb-B43.13 (oregovomab), which has also been extensively reviewed in the Part I review article. The main mechanisms include (a) forming CA125 immune complexes to activate the antigen-presenting cells; (b) triggering induction of CA125-specific immune responses, including anti-CA125 Abs against various epitopes and CA125-specific B and T cell responses; and (c) triggering CD4 and CD8 T-cell responses specific for B43.13 to produce specific and non-specific immune response. With success in vitro, in vivo and in primitive studies, phase II study was conducted to test the effectiveness of chemoimmunotherapy (CIT) for the management of EOC patients. In the 97 EOC patients after optimal debulking surgery (residual tumor <1 cm or no gross residual tumor), patients treated with CIT had a dramatical and statistically significant improvement of both progression-free survival (PFS) and overall survival (OS) compared to those treated with chemotherapy alone with a median PFS of 41.8 months versus 12.2 months (hazard ratio [HR] 0.46, 95 % confidence interval [CI] 0.28-0.7) and OS not yet been reached (NE) versus 42.3 months (HR 0.35, 95 % CI 0.16-0.74), respectively. The current review as Part II will explore the possibility of using CIT as front-line therapy in the management of advanced-stage EOC patients after maximal cytoreductive surgery based on the evidence by many phase 2 studies.
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Affiliation(s)
- Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fang-Wei Chou
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Hsien Liu
- Department of Medical Imaging and Intervention, Tucheng Hospital, New Taipei City, Taiwan
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan.
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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