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Marcinak CT, Schwartz PB, Basree MM, Hurst N, Bassetti M, Kratz JD, Uboha NV. Treatment of Oligometastatic GI Cancers. Am Soc Clin Oncol Educ Book 2024; 44:e430152. [PMID: 38190577 DOI: 10.1200/edbk_430152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Oligometastatic state is believed to potentially represent a transitional stage between early, locoregional state disease and widely metastatic disease. Historically, locoregional approaches, particularly in advanced colorectal cancers, have demonstrated efficacy in select patients with limited burden of metastatic disease. Recent strides in systemic therapies, including biomarker-based treatments and immunotherapy, alongside innovations in surgical techniques and novel locoregional approaches such as stereotactic radiotherapy and ablation, have ushered in a new era of therapeutic possibilities across all oligometastatic GI cancers. Despite these advancements, there remains a significant gap in high-quality prospective evidence guiding patient selection and treatment decisions across various disease types. Ongoing clinical trials are anticipated to provide crucial insights into oligometastatic states, fostering the refinement of disease-specific oligometastatic state definitions and treatment algorithms. This article reviews existing data on the management of oligometastatic GI cancer, summarizes current state of knowledge for each disease state, and provides updates on ongoing studies in this space.
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Affiliation(s)
- Clayton T Marcinak
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Patrick B Schwartz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Mustafa M Basree
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Newton Hurst
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Jeremy D Kratz
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
- Center for Human Genomics and Precision Medicine, University of Wisconsin, Madison, WI
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nataliya V Uboha
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
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Li F, Qu R, Meng Y, Li N, Chen M, Wang H, Zhou X, Fu W. Sigmoid take-off in rectosigmoid cancer as a landmark identifying benefit from neoadjuvant chemoradiation: A retrospective comparative cohort study. Asian J Surg 2023; 46:4330-4336. [PMID: 37803809 DOI: 10.1016/j.asjsur.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is no standard treatment strategy for rectosigmoid cancer because of the diverse definitions of the proximal rectal origin. This study aimed to evaluate sigmoid take-off compared with other landmarks of the rectosigmoid junction in guiding oncological therapy and outcomes. MATERIALS AND METHODS This retrospective, comparative cohort study included patients diagnosed with rectosigmoid carcinoma at our centre between January 2010 and December 2018. The patients were classified into the neoadjuvant treatment group and upfront surgery group. The oncological outcomes were compared between the two groups in relation to the tumor position. RESULTS A total of 656 patients (median age 64 years) were included. After propensity score matching, the 3- and 5-year overall survival and disease-free survival in patients in both the groups were comparable. However, when only patients with rectal cancer as defined by the sigmoid take-off point were included, the disease-free survival rate in the upfront surgery group was significantly lower than that in the neoadjuvant treatment group (p = 0.03 in patients who underwent computed tomography, p = 0.03 in patients who underwent magnetic resonance imaging). The turning point of the beneficial hazard ratio of neoadjuvant therapy was compared according to the different definitions of the rectosigmoid junction and the sigmoid take-off was found to be the most effective. CONCLUSION The sigmoid take-off point is a suitable landmark for identifying the rectosigmoid junction and is an important defining criterion for assessing the benefit of neoadjuvant therapy. The application of this definition in clinical practice and future trials is warranted.
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Affiliation(s)
- Fei Li
- Department of General Surgery, Peking University Third Hospital, Peking University Third Hospital Cancer Center, Beijing, China
| | - Ruize Qu
- Department of General Surgery, Peking University Third Hospital, Peking University Third Hospital Cancer Center, Beijing, China
| | - Yan Meng
- Department of General Surgery, Peking University Third Hospital, Peking University Third Hospital Cancer Center, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Ming Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Peking University Third Hospital Cancer Center, Beijing, China
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Peking University Third Hospital Cancer Center, Beijing, China.
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Ziranu P, Ferrari PA, Guerrera F, Bertoglio P, Tamburrini A, Pretta A, Lyberis P, Grimaldi G, Lai E, Santoru M, Bardanzellu F, Riva L, Balconi F, Della Beffa E, Dubois M, Pinna-Susnik M, Donisi C, Capozzi E, Pusceddu V, Murenu A, Puzzoni M, Mathieu F, Sarais S, Alzetani A, Luzzi L, Solli P, Paladini P, Ruffini E, Cherchi R, Scartozzi M. Clinical score for colorectal cancer patients with lung-limited metastases undergoing surgical resection: Meta-Lung Score. Lung Cancer 2023; 184:107342. [PMID: 37573705 DOI: 10.1016/j.lungcan.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Radical resection of isolated lung metastases (LM) from colorectal cancer (CRC) is debated. Like Fong's criteria in liver metastases, our study was meant to assign a clinical prognostic score in patients with LM from CRC, aiming for better surgery selection. METHODS We retrospectively analyzed data from 260 CRC patients who underwent curative LM resection from December 2002 to January 2022, verifying the impact of different clinicopathological features on the overall survival (OS). RESULTS At the univariate analysis: higher baseline CEA levels (p = 0.0001), disease-free survival less than or equal to 12 months (m) (p = 0.0043), LM size larger than 2 cm (p = 0.0187), multiple resectable nodules (p = 0.0083), and positive nodal status of the primary tumor (p = 0.0011) were associated with worse prognosis. In a Cox regression model, these characteristics retained their independent role for OS (p < 0.0001) and were chosen as criteria to be assigned one point each for clinical risk score. The 5-year survival rate in patients with 0 points was 88%, while no patients with a 5-point score survived at 2 years. Based on the 0-1 vs. 2-5 score range, we obtained a significant difference in median OS: not reached vs. 40.8 months (95 %CI 36 to 87.5), respectively (p < 0.0001) stratifying patients into good and poor prognosis. The prognostic role of the score was also confirmed in terms of median RFS: not reached in 0-1 scored patients vs. 30.5 months (95 %CI 19.4 to 42) in patients with 2-5 scores (p = 0.0006). CONCLUSIONS When LM from CRC is resectable, the Meta-Lung Score provides valuable prognostic information. Indeed, while upfront surgery should be considered in patients with scores of 0 to 1, it should be cautiously suggested in patients with scores of 2 to 5, for whom a prognosis comparison between preventive surgery and other treatments should be investigated in prospective randomized clinical trials.
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Affiliation(s)
- Pina Ziranu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy.
| | - Francesco Guerrera
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pietro Bertoglio
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Tamburrini
- Department of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Andrea Pretta
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Paraskevas Lyberis
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giulia Grimaldi
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Eleonora Lai
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Massimiliano Santoru
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Fabio Bardanzellu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Laura Riva
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Francesca Balconi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Eleonora Della Beffa
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marco Dubois
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Matteo Pinna-Susnik
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Enrico Capozzi
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valeria Pusceddu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Alessandro Murenu
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Marco Puzzoni
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Federico Mathieu
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Sabrina Sarais
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Aiman Alzetani
- Department of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Luca Luzzi
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Piero Paladini
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Enrico Ruffini
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberto Cherchi
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Mario Scartozzi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
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Lee S, Surabhi VR, Kassam Z, Chang KJ, Kaur H. Imaging of colon and rectal cancer. Curr Probl Cancer 2023:100970. [PMID: 37330400 DOI: 10.1016/j.currproblcancer.2023.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
Colon and rectal cancer imaging has traditionally been performed to assess for distant disease (typically lung and liver metastases) and to assess the resectability of the primary tumor. With technological and scientific advances in imaging and the evolution of treatment options, the role of imaging has expanded. Radiologists are now expected to provide a precise description of primary tumor invasion extent, including adjacent organ invasion, involvement of the surgical resection plane, extramural vascular invasion, lymphadenopathy, and response to neoadjuvant treatment, and to monitor for recurrence after clinical complete response.
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Affiliation(s)
- Sonia Lee
- Department of Radiological Sciences, University of California, Irvine, CA.
| | - Venkateswar R Surabhi
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zahra Kassam
- Department of Medical Imaging, Schulich School of Medicine, Western University, St Joseph's Hospital, London, Ontario, Canada
| | - Kevin J Chang
- Department of Radiology, Boston University Medical Center, Boston, MA
| | - Harmeet Kaur
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Haj Khalaf MA, Sirbu H, Hartmann A, Agaimy A, Dudek W, Higaze M, Rieker R. Spread through Air Spaces (STAS) in Solitary Pulmonary Metastases from Colorectal Cancer (CRC). Thorac Cardiovasc Surg 2023; 71:138-144. [PMID: 36257546 PMCID: PMC9998148 DOI: 10.1055/s-0042-1757632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spread through air spaces (STAS) is a recently described route of tumor invasion associated with poor prognosis in primary lung cancer. Aim of this study was to investigate the presence of STAS and to assess its prognostic significance in patients undergoing pulmonary metastasectomy (PM) for solitary metastases from colorectal cancer (CRC). MATERIALS AND METHODS All 49 CRC patients (30 male and 19 female, median age 66 years) who underwent PM between January 2008 and December 2015 were retrospectively analyzed. RESULTS STAS was identified in 26.5% (n = 13) of resected specimens. Location of pulmonary lesions (central vs. peripheral) was assessed based on the available computed tomography imaging (n = 47, 96%). STAS was detected in all five patients with central metastases (100%) versus 7 of 42 (17%) with peripheral metastases (p = 0.0001). Locoregional recurrence occurred in STAS-positive patients (n = 4 of 13 vs. n = 0 of 36), all STAS-negative patients remained recurrence-free (p = 0.003). Median number of alveoli with STAS involvement was four (range from 2 to 9). There was statistically positive relationship between the number of alveoli invaded with STAS and locoregional recurrence of metastases (p = 0.0001). The presence of STAS is not a factor affecting the 5-year overall survival rate (p = 0.6651). CONCLUSION We identified STAS as a frequent finding in resected CRC lung metastases and found insignificant association with outcome.
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Affiliation(s)
- Mohamed Anwar Haj Khalaf
- Division of Thoracic Surgery, Erlangen University Hospital, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Horia Sirbu
- Division of Thoracic Surgery, Erlangen University Hospital, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Pathology Institute, Erlangen University Hospital, Erlangen, Germany
| | - Abbas Agaimy
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Pathology Institute, Erlangen University Hospital, Erlangen, Germany
| | - Wojciech Dudek
- Division of Thoracic Surgery, Erlangen University Hospital, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mostafa Higaze
- Division of Thoracic Surgery, Erlangen University Hospital, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ralf Rieker
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Pathology Institute, Erlangen University Hospital, Erlangen, Germany
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Zhou Y, Wang D, Tan F, Zhou Z, Zhao L, Güngör C, Pei Q, Li Y, Liu W. The survival impact of radiotherapy on synchronous metastatic rectal cancer: metastatic site can serve for radiotherapy-decision. J Cancer 2022; 13:2171-2178. [PMID: 35517420 PMCID: PMC9066223 DOI: 10.7150/jca.70894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: The metastatic site seems to represent a malignancy with a different biological characteristic. Radiotherapy, as a successful, well-tolerated, cost-effective and time-efficient intervention, is able to provide clear benefits for the treatment of locally advanced rectal cancer and has become an essential component of palliative oncology care. The real-world effect of radiotherapy on the survival outcomes of metastatic rectal cancer (mRC) patients might do exist and was worth exploring. Patients and methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database in this retrospective analysis. The statistical methods included Pearson's chi-square test, Log-rank test, Cox regression model and propensity score matching (PSM). Results: The multivariable Cox regression displayed that radiotherapy may not be used as a prognostic factor for mRC (p=0.057). However, radiotherapy may be associated with the prognosis if the metastatic site was excluded from the multivariate analysis (p<0.001). Radiotherapy seemed to fail to improve OS before PSM (p<0.001) and after PSM without the metastatic site as a matching factor (p<0.001). Nevertheless, there was no significant survival difference between radiotherapy and non-radiotherapy cohort after PSM with the metastatic site as a matching factor (p=0.057). All of M1a rectal cancer patients appear to obtain survival benefit from radiotherapy without the impact of PSM (p<0.001). Notwithstanding, radiotherapy was associated with improved OS of patients with rectal liver-limited metastasis (p=0.023) and did not appear to provide survival benefit for rectal lung-limited (p=0.386) and other-limited metastasis (p=0.385). Both of M1b mRC with and without liver metastasis did not seem to obtain survival benefit from radiotherapy. Conclusions: Carefully selected data from the SEER database suggested that radiotherapy appears to improve overall survival only in patients with rectal liver-limited metastasis.
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Affiliation(s)
- Yuan Zhou
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dan Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fengbo Tan
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongyi Zhou
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lilan Zhao
- Department of Thoracic surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Cenap Güngör
- Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Qian Pei
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqiang Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wenxue Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
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Balhareth AS, AlQattan AS, Alshaqaq HM, Alkhalifa AM, Al Abdrabalnabi AA, Alnamlah MS, MacNamara D. Survival and prognostic factors of isolated pulmonary metastases originating from colorectal cancer: An 8-year single-center experience. Ann Med Surg (Lond) 2022; 77:103559. [PMID: 35638071 PMCID: PMC9142401 DOI: 10.1016/j.amsu.2022.103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Isolated pulmonary metastasis (IPM) is a rare entity that accounts for 10% of pulmonary metastases seen in colorectal cancer (CRC). This study aims to evaluate the overall 5-year survival of IPM originating from CRC and identify potential prognostic factors affecting the overall survival (OS). Methods A retrospective cohort study conducted in a tertiary care center. The study included all patients diagnosed with CRC aged 18–75 years who underwent primary tumor resection with curative intent between 2008 and 2015, and developed IPM. Patients with no follow-up and those with extra-pulmonary metastases were excluded. Results The prevalence of IPM in the overall CRC cases was 4.18% (20/478 patients). The mean age of patients with IPM was 52.7 ± 12.9 years. Ten patients had synchronous IPM (50%), thirteen had unilateral (65%), and eleven underwent metastasectomy (55%). The 5-year OS was 40%, and the mean OS was 3.12 ± 1.85 years. Several factors were found to be associated with a favorable outcome, which include unilateral IPM (3.69 vs. 2.07 years; P = 0.024), metachronous (4.25 vs. 2.14 years; P = 0.017), metastasectomy (4.81 vs. 1.83 years; P = 0.005). In addition, mortality was likely to be decreased by more than 90% after metastasectomy (unadjusted odds ratio = 0.071; 95% confidence interval [CI] = 0.01–0.8; P = 0.032). Conclusions Forty percent of the included patients survived the 5-year follow-up. Better survival was associated with the metastases being unilateral, metachronous, and metastasectomy. Mortality was lower in patients with pulmonary recurrence after metastasectomy. IPM showed an incidence of 4% among resectable CRC patients. IPM demonstrated 40% 5-year overall survival. Survival was not influenced by age, comorbidities, KRAS mutation, nor the number of pulmonary lesions. Unilateral lesions, metachronous metastases, and metastasectomy were associated with a favorable outcome. The mortality was likely to be decreased by >90% after metastasectomy.
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Affiliation(s)
- Ameera S. Balhareth
- Colorectal Section, Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Abdullah S. AlQattan
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
- Corresponding author. Department of General Surgery, Building 7, 2nd floor, King Fahad Specialist Hospital-Dammam, Saudi Arabia.
| | - Hassan M. Alshaqaq
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | - Muna S. Alnamlah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Deborah MacNamara
- Department of Colorectal Surgery Beaumont Hospital and National Clinical Programme in Surgery, RCSI, Ireland
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8
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Chiappetta M, Salvatore L, Congedo MT, Bensi M, De Luca V, Petracca Ciavarella L, Camarda F, Evangelista J, Valentini V, Tortora G, Margaritora S, Lococo F. Management of single pulmonary metastases from colorectal cancer: State of the art. World J Gastrointest Oncol 2022; 14:820-832. [PMID: 35582100 PMCID: PMC9048528 DOI: 10.4251/wjgo.v14.i4.820] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.
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Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lisa Salvatore
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Bensi
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Viola De Luca
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Floriana Camarda
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Jessica Evangelista
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Vincenzo Valentini
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giampaolo Tortora
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Hayashi K, Ono Y, Takamatsu M, Oba A, Ito H, Sato T, Inoue Y, Saiura A, Takahashi Y. Prediction of Recurrence Pattern of Pancreatic Cancer Post-Pancreatic Surgery Using Histology-Based Supervised Machine Learning Algorithms: A Single-Center Retrospective Study. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11471-x. [PMID: 35230581 DOI: 10.1245/s10434-022-11471-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with pancreatic cancer (PC) have poor prognosis and a high incidence of recurrence. Since further treatment is applicable for specific recurrent events, it is important to predict recurrence patterns after surgery. This study aimed to identify and predict early and late recurrence patterns of PC using a histology-based machine learning model. PATIENTS AND METHODS Patients who underwent upfront curative surgery for PC between 2001 and 2014 were included. The timing of recurrence and prognosis of each first recurrence site were examined. A histology-based supervised machine learning method, which combined convolutional neural networks and random forest, was used to predict the recurrence and respective sites of metastasis. Accuracy was evaluated using area under the receiver operating characteristic curve (AUC). RESULTS In total, 524 patients were included. Recurrence in the liver accounted for 47.8% of all recurrence events in the first year after surgery. Meanwhile, recurrence in the lung occurred later and could become apparent more than 5 years post-surgery, with indications for further surgery. In terms of substantial distant organ metastases, liver and lung metastases were identified as representative early and late recurrence events. The predictive AUCs of the machine learning model for training and test data were 1.000 and 0.861, respectively, and for predicting nonrecurrence were 1.000 for both. CONCLUSIONS We identified the liver and lung as early and late recurrence sites, which could be distinguished with high probability using a machine learning model. Prediction of recurrence sites using this model may be useful for further treatment of patients with PC.
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Affiliation(s)
- Koki Hayashi
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Yoshihiro Ono
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Manabu Takamatsu
- Division of Pathology, Department of Pathology, Cancer Institute, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
| | - Atsushi Oba
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Hiromichi Ito
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Takafumi Sato
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Yosuke Inoue
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Akio Saiura
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yu Takahashi
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
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10
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Jördens MS, Labuhn S, Luedde T, Hoyer L, Kostev K, Loosen SH, Roderburg C. Prevalence of Lung Metastases among 19,321 Metastatic Colorectal Cancer Patients in Eight Countries of Europe and Asia. Curr Oncol 2021; 28:5035-5040. [PMID: 34940062 PMCID: PMC8700218 DOI: 10.3390/curroncol28060423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Colorectal cancer is one of the most common malignancies in the Western world, and is responsible for about 10% of annual cancer-related deaths. Especially for UICC stage IV, the probability of survival is significantly reduced. Little is known about risk factors for specific metastatic patterns of colorectal cancer that may also influence patients’ overall survival. Methods: We used data from the IQVIA oncology dynamics (OD) database to determine the prevalence of pulmonary metastases in 19,321 patients with UICC stage IV colorectal cancer in eight European and Asian countries. Results: In total, 6132 of 19,321 (31.7%) study patients had lung metastases, with a higher prevalence among patients with rectal (37.5%) than colon (30.1%) cancer. When compared to China as the country with the lowest lung metastases prevalence, the odds for lung metastases were highest in UK (OR: 2.02, 95%CI: 1.80–2.28), followed by Italy (OR: 1.86, 95%CI: 1.52–2.27), Spain (OR: 1.85, 95%CI: 1.64–2.09), and Germany (OR: 1.47, 95%CI: 1.26–1.71). Conclusion: The prevalence of pulmonary metastases in UICC stage IV colorectal cancer varies widely among the different analyzed countries. Although the present data are purely descriptive, a possible combination of ethnic, environmental, and health care system-associated differences could be discussed as the underlying cause. Further studies are needed to investigate the reasons for differences in the prevalence of lung metastases.
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Affiliation(s)
- Markus S. Jördens
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.L.); (T.L.); (S.H.L.); (C.R.)
- Correspondence:
| | - Simon Labuhn
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.L.); (T.L.); (S.H.L.); (C.R.)
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.L.); (T.L.); (S.H.L.); (C.R.)
| | - Laura Hoyer
- Epidemiology, IQVIA, 60549 Frankfurt, Germany; (L.H.); (K.K.)
| | - Karel Kostev
- Epidemiology, IQVIA, 60549 Frankfurt, Germany; (L.H.); (K.K.)
| | - Sven H. Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.L.); (T.L.); (S.H.L.); (C.R.)
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.L.); (T.L.); (S.H.L.); (C.R.)
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11
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Yu L, Xu TL, Zhang L, Shen SH, Zhu YL, Fang H, Zhang HZ. Impact of neoadjuvant chemoradiotherapy on the local recurrence and distant metastasis pattern of locally advanced rectal cancer: a propensity score-matched analysis. Chin Med J (Engl) 2021; 134:2196-2204. [PMID: 34553701 PMCID: PMC8478402 DOI: 10.1097/cm9.0000000000001641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy (NCRT). This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched analysis. METHODS In total, 1296 patients with NCRT or post-operative chemoradiotherapy (PCRT) were enrolled in this study between January 2008 and December 2015. Propensity score matching was used to correct for differences in baseline characteristics between the two groups. After propensity score matching, the metastasis pattern, including metastasis sites and timing, was compared and analyzed. RESULTS After propensity score matching, there were 408 patients in the PCRT group and 245 patients in the NCRT group. NCRT significantly reduced local recurrence (4.1% vs. 10.3%, P = 0.004), but not distant metastases (28.2% vs. 27.9%, P = 0.924) compared with PCRT. In both the NCRT and PCRT groups, the most common metastasis site was the lung, followed by the liver. The NCRT group developed local recurrence and distant metastases later than the PCRT group (median time: 29.2 [18.8, 52.0] months vs. 18.7 [13.3, 30.0] months, Z = -2.342, P = 0.019; and 21.2 [12.2, 33.8] vs. 16.4 [9.3, 27.9] months, Z = -1.765, P = 0.035, respectively). The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group (39/114, 34.2%) and NCRT group (21/69, 30.4%). However, 20.3% (14/69) of the distant metastases appeared in the 3rd year in the NCRT group, while this number was only 13.2% (15/114) in the PCRT group. CONCLUSIONS The predominant site of distant metastases was the lung, followed by the liver, for both the NCRT group and PCRT group. NCRT did not influence the predominant site of distant metastases, but the NCRT group developed local recurrence and distant metastases later than the PCRT group. The follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.
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Affiliation(s)
- Liang Yu
- Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- State Key Lab of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tian-Lei Xu
- Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- State Key Lab of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lin Zhang
- Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- State Key Lab of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuo-Hao Shen
- Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- State Key Lab of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yue-Lu Zhu
- Department of Pathology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hai-Zeng Zhang
- Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- State Key Lab of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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12
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Yin H, Gao T, Xie J, Huang Z, Zhang X, Yang F, Qi W, Yang Z, Zhou T, Gao G, Yang X. FUBP1 promotes colorectal cancer stemness and metastasis via DVL1-mediated activation of Wnt/β-catenin signaling. Mol Oncol 2021; 15:3490-3512. [PMID: 34288405 PMCID: PMC8637553 DOI: 10.1002/1878-0261.13064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/02/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Distant metastasis is, unfortunately, the leading cause of death in colorectal cancer (CRC). Approximately 50% of CRC patients develop liver metastases, while 10–30% of patients develop pulmonary metastases. The occurrence of metastasis is considered to be almost exclusively driven by cancer stem cells (CSCs) formation. However, the key molecules that confer the transformation to stem cells in CRC, and subsequent metastasis, remain unclear. Far upstream element‐binding protein 1 (FUBP1), a transcriptional regulator of c‐Myc, was screened in CSCs of CRC by mass spectrometry and was examined by immunohistochemistry in a cohort of CRC tissues. FUBP1 was upregulated in 85% of KRAS‐mutant and 25% of wild‐type CRC patients. Further, whether in KRAS‐mutant or wild‐type patients, elevated FUBP1 was positively correlated with CRC lymph node metastasis and clinical stage, and negatively associated with overall survival. Overexpression of FUBP1 significantly enhanced CRC cell migration, invasion, tumor sphere formation, and CD133 and ALDH1 expression in vitro, and tumorigenicity in vivo. Mechanistically, FUBP1 promoted the initiation of CSCs by activating Wnt/β‐catenin signaling via directly binding to the promoter of DVL1, a potent activator of β‐catenin. Knockdown of DVL1 significantly inhibited the transformation to stem cells in, as well as the tumorigenicity of, CRC. Activation of Wnt/β‐catenin signaling by DVL1 increased pluripotent transcription factors, including c‐Myc, NANOG, and SOX2. Moreover, FUBP1 was upregulated at the post‐transcriptional level. Elevated FUBP1 levels in KRAS wild‐type CRC patients is due to the decrease in Smurf2, which promotes ubiquitin‐mediated degradation of FUBP1. In contrast, FUBP1 was upregulated in KRAS‐mutant patients through both inhibition of caspase 3‐dependent cleavage and decreased Smurf2. Our results demonstrate, for the first time, that FUBP1 is an oncogene, initiating the development of CSCs, as well as a new powerful endogenous Wnt‐signaling agonist that could provide an important prognostic factor and therapeutic target for metastasis in both KRAS‐mutant and wild‐type CRC.
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Affiliation(s)
- Haofan Yin
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tianxiao Gao
- Department of Biochemistry, Zhongshan School of Medicine, SunYat-sen University, Guangzhou, China
| | - Jinye Xie
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhijian Huang
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaoyan Zhang
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fengyu Yang
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Weiwei Qi
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhonghan Yang
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ti Zhou
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guoquan Gao
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Engineering & Technology Research Center for Gene Manipulation and Biomacromolecular Products, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, China
| | - Xia Yang
- Program of Molecular Medicine, Affiliated Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
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13
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Fenton HM, Finan PJ, Milton R, Shackcloth M, Taylor JC, Treasure T, Morris EJA. National variation in pulmonary metastasectomy for colorectal cancer. Colorectal Dis 2021; 23:1306-1316. [PMID: 33368958 PMCID: PMC8614123 DOI: 10.1111/codi.15506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
AIM Evidence on patterns of use of pulmonary metastasectomy in colorectal cancer patients is limited. This population-based study aims to investigate the use of pulmonary metastasectomy in the colorectal cancer population across the English National Health Service (NHS) and quantify the extent of any variations in practice and outcome. METHODS All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2013 were identified in the COloRECTal cancer data Repository (CORECT-R). All inpatient episodes corresponding to pulmonary metastasectomy, occurring within 3 years of the initial colorectal resection, were identified. Multi-level logistic regression was used to determine patient and organizational factors associated with the use of pulmonary metastasectomy for colorectal cancer, and Kaplan-Meier and Cox models were used to assess survival following pulmonary metastasectomy. RESULTS In all, 173 354 individuals had a major colorectal resection over the study period, with 3434 (2.0%) undergoing pulmonary resection within 3 years. The frequency of pulmonary metastasectomy increased from 1.2% of patients undergoing major colorectal resection in 2005 to 2.3% in 2013. Significant variation was observed across hospital providers in the risk-adjusted rates of pulmonary metastasectomy (0.0%-6.8% of patients). Overall 5-year survival following pulmonary resection was 50.8%, with 30-day and 90-day mortality of 0.6% and 1.2% respectively. CONCLUSIONS This study shows significant variation in the rates of pulmonary metastasectomy for colorectal cancer across the English NHS.
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Affiliation(s)
- Hayley M. Fenton
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Paul J. Finan
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Richard Milton
- Department of Thoracic SurgerySt James’s University HospitalLeedsUK
| | - Michael Shackcloth
- Department of Thoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUK
| | - John C. Taylor
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Tom Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
| | - Eva J. A. Morris
- Nuffield Department of Population HealthBig Data InstituteUniversity of OxfordOxfordUK
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14
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Ishimaru K, Kawai K, Nozawa H, Sasaki K, Murono K, Emoto S, Ishii H, Anzai H, Sonoda H, Yamauchi S, Sugihara K, Ishihara S. Hazard function analysis of metastatic recurrence after colorectal cancer surgery-A nationwide retrospective study. J Surg Oncol 2021; 123:1015-1022. [PMID: 33444465 DOI: 10.1002/jso.26378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES An optimal postoperative surveillance protocol for colorectal cancer (CRC) is dependent on understanding the time line of recurrence. By hazard function analysis, this study aimed at evaluating the time of occurrence of metastasis. METHODS A total of 21,671 Stage I-III colon cancer patients were retrospectively included from the Japanese study group for postoperative follow-up of colorectal cancer database. RESULTS The 5-year incidence by metastasized organ was 6.3% for liver (right:left = 5.5%:7.0%, p = .0067), 6.0% for lung (right:left:rectum = 3.7%:4.4%:8.8%, p = 7.05E-45), and 2.0% for peritoneal (right:left:rectum = 3.1%:2.0%:1.2%, p = 1.29E-12). The peak of liver metastasis hazard rate (HR) (0.67 years) was earlier and higher than those of other metastases. The peak HR tended to be delayed in early stage CRCs (0.91, 0.76, and 0.52 years; for Stages I, II, and III, respectively). When analyzed as per the primary tumor location (right-sided, left-sided, and rectum), the peak HR for lung metastasis was twice as high for rectal cancer than for colon cancer, and peritoneal metastasis had a high HR in right-sided colon cancers. CONCLUSION The time course for the risk of recurrence in various metastatic organs based on the primary tumor site was clearly visualized in this study. This will aid in individualizing postoperative surveillance schedules.
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Affiliation(s)
- Kazuhiro Ishimaru
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Ishii
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Anzai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | | | | | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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15
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Kim HG, Kim HS, Yang SY, Han YD, Cho MS, Hur H, Min BS, Lee KY, Kim NK. Early recurrence after neoadjuvant chemoradiation therapy for locally advanced rectal cancer: Characteristics and risk factors. Asian J Surg 2020; 44:298-302. [PMID: 32718796 DOI: 10.1016/j.asjsur.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 07/16/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/OBJECTIVE Some locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (CRT) prior to total mesorectal excision (TME) show early recurrence with a short disease-free interval. This is unacceptable for patients and their families, necessitating re-evaluation of the treatment process. We aimed to evaluate the risk factors and prognostic impact of early recurrence in patients who received preoperative CRT (pCRT) followed by TME for LARC. METHODS Of 714 patients who underwent curative resection after pCRT for LARC from January 2010 to December 2016, we included 139 who developed recurrence after resection. Patients were divided into an early recurrence group, diagnosed <12 months after primary surgery, and a late recurrence group, diagnosed ≥12 months after primary surgery. RESULTS Forty-nine patients experienced early recurrence and 90 experienced late recurrence. Multivariate analysis revealed that tumor regression grade (hazard ratio [HR] 2.962, 95% confidence interval [CI] 1.434-6.119, P = 0.003) and positive ypN stage (HR 2.110, 95% CI 1.144-3.892, P = 0.017) correlated with early recurrence. The 5-year overall survival rates for early and late recurrences were not significantly different (P = 0.121). CONCLUSION In patients with early recurrence after pCRT followed by TME, tumor regression grade and ypN stage positivity were independent predictors of the early recurrence.
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Affiliation(s)
- Han-Gil Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Ho Seung Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Yoon Yang
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Dae Han
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Soo Cho
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk Hur
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Young Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Kyu Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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16
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Zhang T, Wang Z, Liu Y, Huo Y, Liu H, Xu C, Mao R, Zhu Y, Liu L, Wei D, Liu G, Pan B, Tang Y, Zhou Z, Yang C, Guo Y. Plastin 1 drives metastasis of colorectal cancer through the IQGAP1/Rac1/ERK pathway. Cancer Sci 2020; 111:2861-2871. [PMID: 32350953 PMCID: PMC7419044 DOI: 10.1111/cas.14438] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022] Open
Abstract
Tumor metastasis is the dominant cause of death in colorectal cancer (CRC) patients, and it often involves dysregulation of various cytoskeletal proteins. Plastin 1 (PLS1) is an actin-bundling protein that has been implicated in the structure of intestinal epithelial microvilli; however, its role in CRC metastasis has not yet been determined. In this study, we demonstrated that PLS1 is highly expressed in 33.3% (45/135) of CRC patients and is correlated with lymph node metastasis and poor survival. In in vitro and in vivo experiments, PLS1 induced the migration and invasion of CRC cells and the metastases to the liver and lung in mice. Moreover, the expressions of key factors for CRC metastases, matrix metalloproteinase (MMP) 9 and 2, were enhanced by PLS1, which was dependent on phosphorylating ERK1/2 activated by IQGAP1/Rac1 signaling. The connection between these signals and PLS1 was further confirmed in CRC tissues of patients and the metastatic nodules from a mouse model. These findings suggest that PLS1 promotes CRC metastasis through the IQGAP1/Rac1/ERK pathway. Targeting PLS1 may provide a potential approach to inhibit the metastasis of CRC cells.
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Affiliation(s)
- Tongtong Zhang
- Medical Research Center, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanjun Liu
- Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yongxu Huo
- Life Science College of Sichuan University, Chengdu, China
| | - Hongtao Liu
- Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Chenxin Xu
- Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Rui Mao
- Department of General Surgery, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yifang Zhu
- Medical Research Center, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
| | - Lei Liu
- Medical Research Center, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
| | - Danfeng Wei
- Medical Research Center, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
| | - Guanzhi Liu
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Biran Pan
- Medical Research Center, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
| | - Yan Tang
- Department of Pathology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
| | - Zheng Zhou
- Medical Research Center, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
| | - Chunlei Yang
- Life Science College of Sichuan University, Chengdu, China
| | - Yuanbiao Guo
- Medical Research Center, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu, China
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17
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Ge Y, Lei S, Cai B, Gao X, Wang G, Wang L, Wang Z. Incidence and prognosis of pulmonary metastasis in colorectal cancer: a population-based study. Int J Colorectal Dis 2020; 35:223-232. [PMID: 31823051 DOI: 10.1007/s00384-019-03434-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE It is unclear how primary tumor location affects the pulmonary metastasis in colorectal cancer patients with different primary tumor locations. We aim to explore the relationship between primary tumor location and the incidence and prognosis of colorectal cancer patients with pulmonary metastasis at diagnosis. METHODS From Surveillance, Epidemiology, and End Results (SEER) database, 9920 out of 192,969 CRC patients were identified with pulmonary metastasis at diagnosis between 2010 and 2015. Patients were classified into three subsets according to primary tumor location. The incidence of pulmonary metastasis and median survival were calculated. Multivariable logistic and Cox regression were performed to identify the risk factors of pulmonary metastasis and prognosis. RESULTS The incidence of pulmonary metastasis was 5.14% in the entire colorectal cancer cohort and 25.66% in metastatic colorectal cancer patients. The median survival of those patients was 10 months. Rectal cancer patients exhibited the highest incidence of pulmonary metastasis, while they had the longest median survival (15 months). The right-sided colon cancer patients had the lowest incidence of pulmonary metastasis, but the shortest median survival (8 months). 61 to 80 years old, over 80, black, two or three extrapulmonary metastatic sites and CEA-positive had a negative influence both on the incidence and prognosis. CONCLUSIONS The importance of primary tumor location in affecting the incidence of pulmonary metastasis and prognosis of colorectal cancer patients was highlighted in this study. Primary tumor location should be considered in clinical interference and personalized treatment for colorectal cancer patients with pulmonary metastasis.
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Affiliation(s)
- Yizhi Ge
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shijun Lei
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bo Cai
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiang Gao
- Jame J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Lin Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Zheng Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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18
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Yang L, Yang X, He W, Liu S, Jiang C, Xie K, Peng K, You Y, Zhang B, Xia L. Comparisons of metastatic patterns of colorectal cancer among patients by age group: a population-based study. Aging (Albany NY) 2019; 10:4107-4119. [PMID: 30594909 PMCID: PMC6326680 DOI: 10.18632/aging.101700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/03/2018] [Indexed: 01/05/2023]
Abstract
Population-based evaluations of the incidence of metastatic colorectal cancer at diagnosis among different age groups are lacking. Therefore, we investigated the effects of age at diagnosis on metastatic colorectal cancer and patients’ prognoses. The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with metastatic colorectal cancer. Multivariate Cox regression analyses were performed to identify factors associated with poor survival. The Kaplan–Meier analysis was used to estimate survival differences between the subgroups. We identified 30,333 adult patients diagnosed with metastatic colorectal cancer between 2010 and 2014. The younger and middle-aged groups had better survival than the older group when brain metastasis was not involved. The liver was the most common site of metastasis followed by the liver and lung combined. Age at diagnosis was an independent factor in patients’ survival. Survival differences between two and three-sites of metastases were found in the middle-aged and older groups but not in the younger group. No survival differences between three and four sites of metastases were found in any of the age groups. Therefore, the incidence and prognosis of metastatic sites for metastatic colorectal cancer varied by age group.
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Affiliation(s)
- Lin Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xingli Yang
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Wenzhuo He
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Shousheng Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Chang Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kunqian Xie
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kunwei Peng
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yafei You
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Bei Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Liangping Xia
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
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19
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Zhang C, Tan Y, Xu H. Does adjuvant chemotherapy improve the prognosis of patients after resection of pulmonary metastasis from colorectal cancer? A systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:1661-1671. [PMID: 31446479 DOI: 10.1007/s00384-019-03362-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND It remains controversial whether patients benefit from adjuvant chemotherapy (ACT) after resection of pulmonary metastasis (PM) from colorectal cancer (CRC). This meta-analysis was intended to evaluate the efficacy of ACT in patients after resection of PM from CRC. METHODS We systematically retrieved articles from PMC, PubMed, Cochrane Library, and Embase (up to March 5, 2019). Survival data, including overall survival (OS) and disease-free survival (DFS), were tested by hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS We included 18 cohort studies with a total of 3885 patients. The meta-analysis showed that ACT had no significant effect on OS (HR = 0.78; 95% CI = 0.60-1.03; P = 0.077) and DFS (HR = 0.91; 95% CI = 0.74-1.11; P = 0.339) in patients after resection of PM from CRC. There was no significant difference in OS (HR = 0.79; 95% CI = 0.42-1.50; P = 0.474) in patients after resection of PM from CRC treated with bevacizumab (BV). Subgroup analysis showed that ACT did not improve OS (HR = 0.86; 95% CI = 0.57-1.29; P = 0.461) in patients who had undergone previous resection of extra PM. ACT did not improve OS in patients who had positive hilar/mediastinal lymph node metastasis (HR = 0.80; 95% CI = 0.57-1.14; P = 0.22). CONCLUSION In conclusion, ACT does not provide survival benefits for patients after resection of PM from CRC. ACT and targeted agents (BV) are not suggested for these patients.
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Affiliation(s)
- Chao Zhang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Yuen Tan
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Huimian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China. .,Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
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20
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Phillips JD, Hasson RM. Surgical management of colorectal lung metastases. J Surg Oncol 2019; 119:629-635. [PMID: 30811031 DOI: 10.1002/jso.25425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/05/2019] [Accepted: 02/10/2019] [Indexed: 12/17/2022]
Abstract
Pulmonary metastasectomy for colorectal cancer is an established means of treatment for select patients. This article will highlight the recent evidence published in the literature related to current practices for the surgical management of colorectal lung metastases and propose a diagnostic algorithm for use in clinical practice. It will also discuss controversies related to pulmonary metastasectomy, including the optimal timing of surgery, the extent of lymph node sampling/dissection, and the extent of surgical resection.
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Affiliation(s)
- Joseph D Phillips
- Department of Surgery, Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Rian M Hasson
- Department of Surgery, Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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21
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Lee RM, Cardona K, Russell MC. Historical perspective: Two decades of progress in treating metastatic colorectal cancer. J Surg Oncol 2019; 119:549-563. [PMID: 30806493 DOI: 10.1002/jso.25431] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
Colorectal cancer is the third most commonly diagnosed cancer in the United States. While screening methods strive to improve rates of early stage detection, 25% of patients have metastatic disease at the time of diagnosis, with the most common sites being the liver, lung, and peritoneum. While once perceived as hopeless, the last two decades have seen substantial strides in the medical, surgical, and regional therapies to treat metastatic disease offering significant improvements in survival.
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Affiliation(s)
- Rachel M Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kenneth Cardona
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Maria C Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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22
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Bozkaya Y, Albayrak I, Tucer D, Kaya Z, Usta U. Late-Onset Lung Metastasis in Rectum Cancer Can Be Confused with Primary Lung Cancer; a Case Report and Literature Review. J Gastrointest Cancer 2019; 50:1029-1033. [PMID: 30613927 DOI: 10.1007/s12029-018-00190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y Bozkaya
- Clinic of Medical Oncology, Edirne State Hospital, 22030, Edirne, Turkey.
| | - I Albayrak
- Clinic of Thoracic Surgery, Edirne State Hospital, Edirne, Turkey
| | - D Tucer
- Clinic of Gastroenterology, Edirne State Hospital, Edirne, Turkey
| | - Z Kaya
- Clinic of Radiology, Edirne State Hospital, Edirne, Turkey
| | - U Usta
- Department of Pathology, Trakya University Faculty of Medicine, Edirne, Turkey
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23
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Handy JR, Bremner RM, Crocenzi TS, Detterbeck FC, Fernando HC, Fidias PM, Firestone S, Johnstone CA, Lanuti M, Litle VR, Kesler KA, Mitchell JD, Pass HI, Ross HJ, Varghese TK. Expert Consensus Document on Pulmonary Metastasectomy. Ann Thorac Surg 2018; 107:631-649. [PMID: 30476477 DOI: 10.1016/j.athoracsur.2018.10.028] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 12/17/2022]
Affiliation(s)
- John R Handy
- Thoracic Surgery, Providence Health & Services, Portland, Oregon.
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Todd S Crocenzi
- Medical Oncology, Providence Cancer Center, Providence Health & Services, Portland, Oregon
| | - Frank C Detterbeck
- Section of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Hiran C Fernando
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Panos M Fidias
- Medical Oncology, Center for Cancer Care, Exeter Hospital, Exeter, New Hampshire
| | | | - Candice A Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Virginia R Litle
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Kenneth A Kesler
- Section of Thoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, Langone Medical Center, New York University School of Medicine, New York, New York
| | - Helen J Ross
- Division of Hematology/Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
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24
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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25
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Hofmann HS, Doblinger C, Szöke T, Grosser C, Potzger T, Ried M, Neu R. [Influence of primary lymph node status of colorectal cancer on the development of pulmonary metastases and thoracic lymph node metastases]. Chirurg 2018; 90:403-410. [PMID: 30276427 DOI: 10.1007/s00104-018-0742-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The lungs are the second most common organ site for metastases in patients with colorectal cancer (CRC). Lymph node metastasis of CRC represents a prognostic factor for survival. OBJECTIVE The present study investigated the influence of CRC lymph node metastasis on lung metastasis, in particular thoracic lymph node metastasis. MATERIAL AND METHODS A retrospective analysis of 88 patients (n = 56 male) with curative resection of lung metastases of CRC was performed. Primary endpoint: influence of lymph node status of CRC on lung metastases. Secondary endpoints: disease-free survival and overall survival. Statistical evaluation was carried out with SPSS. RESULTS In 48 patients a positive lymph node status of CRC and in 9 patients an N+ status of lung metastases were determined. The lymph node status of the CRC significantly affected the incidence of synchronous metastases (p = 0.03), disease-free interval until formation of metachronous lung metastases (p = 0.012) and the overall survival of patients with CRC (p = 0.048). The 5‑year survival rate for CRC patients with lung metastases was 48.7% after pulmonary metastasectomy. Thoracic lymph node involvement also significantly affected survival (p = 0.001). CONCLUSION Screening for pulmonary metastases should be included in the staging and follow-up of all patients with CRC, especially in patients with a positive lymph node status of the CRC.
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Affiliation(s)
- H-S Hofmann
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland. .,Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
| | - C Doblinger
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - T Szöke
- Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
| | - C Grosser
- Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
| | - T Potzger
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - M Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - R Neu
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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26
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Menna C, Berardi G, Tierno SM, Andreetti C, Maurizi G, Ciccone AM, D’Andrilli A, Cassiano F, Poggi C, Diso D, Venuta F, Rendina EA, Ibrahim M. Do Repeated Operations for Recurrent Colorectal Lung Metastases Result in Improved Survival? Ann Thorac Surg 2018; 106:421-427. [DOI: 10.1016/j.athoracsur.2018.02.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 02/06/2023]
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27
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Zheng B, Ohuchida K, Yan Z, Okumura T, Ohtsuka T, Nakamura M. Primary Recurrence in the Lung is Related to Favorable Prognosis in Patients with Pancreatic Cancer and Postoperative Recurrence. World J Surg 2017; 41:2858-66. [PMID: 28634843 DOI: 10.1007/s00268-017-4068-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The pattern of recurrence affects the clinical outcome in tumor patients. However, the clinical significance of lung metastasis as the primary recurrence site after resection in patients with pancreatic cancer remains unclear. This study aimed to clarify the clinical significance of the primary recurrence site in patients with pancreatic cancer, in terms of prognosis and clinicopathological features. METHODS This retrospective cohort study included 220 patients with postoperative recurrence after pancreatectomy for pancreatic cancer and classified by primary site of recurrence. We focused on patients with lung metastasis as the primary recurrence and investigated its correlation with prognosis and clinicopathological factors. RESULTS Twenty-four (11%) patients had lung metastasis as the primary recurrence. This recurrence pattern had the best prognosis among all recurrence patterns, including liver metastasis and local recurrence. Patients with lung metastasis as the primary recurrence had favorable overall survival and survival from the date of recurrence compared with patients with other primary recurrence sites in both univariate (P = 0.0008 and P = 0.0005) and multivariate analyses (P = 0.0051 and P = 0.0068). In terms of clinicopathological features of resected pancreatic tumors, lung metastasis as the primary recurrence was associated with lower tumor stage and histologic grade, and less vascular invasion and residual tumor volume than liver metastasis. CONCLUSIONS Pancreatic cancer patients with lung metastasis as the primary recurrence after pancreatectomy have a better prognosis than those with other recurrence patterns.
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28
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Abstract
OBJECTIVES This study aim to investigate the incidence, timing and risk factors of metachronous pulmonary recurrence after curative resection in patients with rectal cancer. DESIGN A retrospective cohort study. SETTING This study was conducted at a tertiary referral cancer hospital. PARTICIPANTS A total of 404 patients with rectal cancer who underwent curative resection from 2007 to 2012 at Beijing Hospital were enrolled in this study. INTERVENTIONS The pattern of recurrence was observed and evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES The incidence and timing of recurrences by site were calculated, and the risk factors of pulmonary recurrence were analysed. RESULTS The 5-year disease-free survival for the entire cohort was 77.0%. The most common site of recurrence was the lungs, with an incidence of 11.4%, followed by liver. Median interval from rectal surgery to diagnosis of pulmonary recurrence was much longer than that of hepatic recurrence (20 months vs 10 months, P=0.022). Tumour location, pathological tumor-node-metastasis (TNM) stage and positive circumferential resection margin were identified as independent risk factors for pulmonary recurrence. A predictive model based on the number of risk factors identified on multivariate analysis was developed, 5-year pulmonary recurrence-free survival for patients with 0, 1, 2 and 3 risk factors was 100%, 90.4%, 77.3% and 70.0%, respectively (P<0.001). CONCLUSIONS This study emphasised that the lung was the most common site of metachronous metastasis in patients with rectal cancer who underwent curative surgery. For patients with unfavourable risk profiles, a more intensive surveillance programme that could lead to the early detection of recurrence is strongly needed.
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Affiliation(s)
- Hong-Da Pan
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Gang Zhao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qi An
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Gang Xiao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
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29
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Littlechild J, Junejo M, Simons AM, Curran F, Subar D. Emergency resection surgery for colorectal cancer: Patterns of recurrent disease and survival. World J Gastrointest Pathophysiol 2018; 9:8-17. [PMID: 29487762 PMCID: PMC5823701 DOI: 10.4291/wjgp.v9.i1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate prognostic pathological factors associated with early metachronous disease and adverse long-term survival in these patients.
METHODS Clinical and histological features were analysed retrospectively over an eight-year period for prognostic impact on recurrent disease and overall survival in patients undergoing curative resection of a primary colorectal cancer.
RESULTS A total of 266 patients underwent curative surgery during the study period. The median age of the study cohort was 68 year (range 26 to 91) with a follow-up of 7.9 years (range 4.6 to 12.6). Resection was undertaken electively in 225 (84.6%) patients and emergency resection in 35 (13.2%). Data on timing of surgery was missing in 6 patients. Recurrence was noted in 67 (25.2%) during the study period and was predominantly early within 3 years (82.1%) and involved hepatic metastasis in 73.1%. Emergency resection (OR = 3.60, P = 0.001), T4 stage (OR = 4.33, P < 0.001) and lymphovascular invasion (LVI) (OR = 2.37, P = 0.032) were associated with higher risk of recurrent disease. Emergency resection, T4 disease and a high lymph node ratio (LNR) were strong independent predictors of adverse long-term survival.
CONCLUSION Emergency surgery is associated with adverse disease free and long-term survival. T4 disease, LVI and LNR provide strong independent predictive value of long-term outcome and can inform surveillance strategies to improve outcomes.
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Affiliation(s)
- Joe Littlechild
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Muneer Junejo
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Anne-Marie Simons
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Finlay Curran
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Darren Subar
- Hepatobiliary Surgery Unit, Royal Blackburn Hospital, Blackburn BB2 3HH, United Kingdom
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Abstract
Tumor metastases are the basic biological characteristics of malignant tumors, and the lungs are the second most prominent metastatic organs in which these develop after the liver. Currently, with the rapid development of ablation technology, ablation therapy as a local treatment is playing an increasingly important role in the treatment of lung metastases. Whether alone or in combination with other treatments, ablation therapy has achieved good therapeutic effects for the treatment of partial lung metastases. This article briefly summarizes the results of current and previous ablation treatments for lung metastases, and focuses on the value of ablation therapy for different kinds of lung metastases.
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Affiliation(s)
- Han Qi
- Minimally Invasive Interventional Division, Medical Imaging CenterSun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Weijun Fan
- Minimally Invasive Interventional Division, Medical Imaging CenterSun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
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Acciuffi S, Meyer F, Bauschke A, Settmacher U, Lippert H, Croner R, Altendorf-Hofmann A. Analysis of prognostic factors after resection of solitary liver metastasis in colorectal cancer: a 22-year bicentre study. J Cancer Res Clin Oncol. 2018;144:593-599. [PMID: 29340767 DOI: 10.1007/s00432-018-2583-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/11/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE The investigation of the predictors of outcome after hepatic resection for solitary colorectal liver metastasis. METHODS We recruited 350 patients with solitary colorectal liver metastasis at the University Hospitals of Jena and Magdeburg, who underwent curative liver resection between 1993 and 2014. All patients had follow-up until death or till summer 2016. RESULTS The follow-up data concern 96.6% of observed patients. The 5- and 10-year overall survival rates were 47 and 28%, respectively. The 5- and 10-year disease-free survival rates were 30 and 20%, respectively. The analysis of the prognostic factors revealed that the pT category of primary tumour, size and grade of the metastasis and extension of the liver resection had no statistically significant impact on survival and recurrence rates. In multivariate analysis, age, status of lymph node metastasis at the primary tumour, location of primary tumour, time of appearance of the metastasis, the use of preoperative chemotherapy and the presence of extrahepatic tumour proved to be independent statistically significant predictors for the prognosis. Moreover, patients with rectal cancer had a lower intrahepatic recurrence rate, but a higher extrahepatic recurrence rate. CONCLUSION The long-term follow-up of patients with R0-resected liver metastasis is multifactorially influenced. Age and comorbidity have a role only in the overall survival. More than three lymph node metastasis reduced both the overall and disease-free survival. Extrahepatic tumour had a negative influence on the extrahepatic recurrence and on the overall survival. Neither overall survival nor recurrence rates was improved using neoadjuvant chemotherapy.
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Abstract
Surgical treatment of metastatic colorectal cancer offers a chance for cure or prolonged survival, particularly for those with more favorable prognostic factors and limited tumor burden. The treatment plan requires multidisciplinary evaluation because multiple therapy options exist. Advanced surgical techniques, adjuncts to resection, and modern chemotherapy all contribute to best outcomes for patients with hepatic metastases. Although cure is less common for patients with metastasis to lung or peritoneum, surgical resection for the former and cytoreduction and intraperitoneal chemotherapy for the latter may help to achieve cancer control in selected patients.
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Affiliation(s)
- Jeffery Chakedis
- Division of Surgical Oncology, Department of Surgery, Complex General Surgical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital and Solove Research Institute, 395 West 12th Avenue, Suite 670, Columbus, OH 43210-1267, USA
| | - Carl R Schmidt
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital and Solove Research Institute, 395 West 12th Avenue, Suite 670, Columbus, OH 43210-1267, USA.
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Liu H, Cui Y, Shen W, Fan X, Cui L, Zhang C, Ren G, Fu J, Wang D. Pretreatment magnetic resonance imaging of regional lymph nodes with carcinoembryonic antigen in prediction of synchronous distant metastasis in patients with rectal cancer. Oncotarget 2017; 7:27199-207. [PMID: 27070083 PMCID: PMC5053642 DOI: 10.18632/oncotarget.7979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/23/2016] [Indexed: 01/14/2023] Open
Abstract
Distant metastasis in patients with rectal cancer remains a problem influencing prognosis. Prediction of synchronous distant metastasis is important for the choice of personalized treatment strategies and postoperative follow-up protocol. So far, there are few studies about the predictive value of MRI features combined with clinical characteristics for synchronous distant metastasis in rectal cancer, especially for the lesions developed within 6 months after surgery. We retrospectively reviewed the pretreatment clinical characteristics and magnetic resonance imaging (MRI) features of 271 patients from January 2010 to December 2011with pathologically confirmed rectal adenocarcinoma and tried to identify independent risk factors for synchronous distant metastasis. Forty-nine patients (18.1%) were confirmed to have synchronous distant metastasis. Multivariate logistic regression model demonstrated that the elevated carcinoembryonic antigen (CEA), positive MRI-predicted lymph nodes staging (mrN), and MRI-predicted mesorectal fascia (mrMRF) involvement were independent risk factors. The odd ratios were 12.2 for elevated CEA, 5.4 for mrN1 and 7.6 for mrN2, and 3.8 for mrMRF involvement, respectively. The accuracy and specificity for predicting synchronous distant metastasis by evaluating the positive mrN combined with elevated CEA were improved to 87.8% and 94.6%, respectively. The accuracy, sensitivity and specificity of positive mrN assessment were 86.1%, 71.4% and 91.7%, respectively using the histopathologic results as the reference standard. Altogether, our findings suggest that pretreatment positive mrN and elevated CEA are independent risk factors for synchronous distant metastasis in rectal cancer and combination of both could help to recognize the patients with high risk for structuring personalized treatment protocol.
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Affiliation(s)
- Huanhuan Liu
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Yanfen Cui
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Wei Shen
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Xingwen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Long Cui
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Caiyuan Zhang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Gang Ren
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Jihong Fu
- Department of Colorectal and Anal Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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Zeng WG, Liu MJ, Zhou ZX, Wang ZJ. A Distal Resection Margin of ≤1 mm and Rectal Cancer Recurrence After Sphincter-Preserving Surgery: The Role of a Positive Distal Margin in Rectal Cancer Surgery. Dis Colon Rectum 2017; 60:1175-83. [PMID: 28991082 DOI: 10.1097/DCR.0000000000000900] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is little information about the prognostic value of a microscopically positive distal margin in patients who have rectal cancer. OBJECTIVE We aimed to investigate the influence of a distal margin of ≤1 mm on oncologic outcomes after sphincter-preserving resection for rectal cancer. DESIGN This is a retrospective cohort study. SETTINGS The study was conducted at 2 hospitals. PATIENTS A total of 6574 patients underwent anterior resection for rectal cancer from January 1999 to December 2014; 97 (1.5%) patients with a distal margin of ≤1 mm were included in this study. For comparative analyses, patients were matched with 194 patients with a negative distal margin (>1 mm) according to sex, age, BMI, ASA score, neoadjuvant treatment, tumor location, and stage. MAIN OUTCOME MEASURES The oncologic outcomes of the 2 groups were compared. RESULTS Perineural and lymphovascular invasion rates were significantly higher in patients with a positive distal margin (54.6% vs 28.9%; 67.0% vs 42.8%; both p < 0.001) compared with to patients with negative distal margin. Comparison between microscopically positive and negative distal margin showed worse oncologic outcomes in patients with a microscopically positive distal margin, including 5-year local recurrence rate (24.1% vs 12.0%, p = 0.005); 5-year distant recurrence rate (35.5% vs 20.2%, p = 0.011); 5-year disease-free survival (45.5% vs 69.5%, p < 0.001); and 5-year OS (69.2% vs 79.7%, p = 0.004). Among the 97 patients with a microscopically positive distal margin, the 5-year disease-free survival rate was higher in patients who received adjuvant therapy (52.0% vs 30.7%, p = 0.089). LIMITATIONS This is a retrospective study; bias may exist. CONCLUSIONS A distal margin of 1 mm is associated with worse oncologic results. Our data indicate the importance of achieving a clear distal margin in the surgical treatment of rectal cancer. Adjuvant therapy should be used in these patients to reduce recurrence. See Video Abstract at http://links.lww.com/DCR/A408.
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Passot G, Kim BJ, Glehen O, Mehran RJ, Kopetz SE, Goere D, Overman MJ, Pocard M, Marchal F, Conrad C, Aloia TA, Vauthey JN, Chun YS. Impact of RAS Mutations in Metastatic Colorectal Cancer After Potentially Curative Resection: Does Site of Metastases Matter? Ann Surg Oncol 2017; 25:179-187. [PMID: 29071660 DOI: 10.1245/s10434-017-6141-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND RAS mutation status is an important prognostic factor after resection of liver metastases (LiM) from colorectal cancer (CRC). The prognostic significance of RAS after resection of lung (LuM) and peritoneal (PM) metastases from CRC is unknown. METHODS Between 2005 and 2014, all consecutive patients with known RAS status who underwent potentially curative resection for LiM, LuM, or PM were evaluated. RESULTS A total of 720 patients with known RAS status underwent resection of LiM (n = 468), LuM (n = 102), and PM (n = 150). RAS mutations were identified in 63 and 58% of patients with LuM and PM, respectively, compared with 41% of patients with LiM (p < 0.001). Five-year overall survival (OS) after resection of PM was 45%, compared with 52% after resection of LiM (p = 0.018) and 64% after resection of LuM (p = 0.005). RAS mutations were associated with significantly worse OS after resection of LiM (p < 0.001), but did not affect OS among patients undergoing resection of LuM (p = 0.41) and PM (p = 0.65). CONCLUSIONS RAS mutations are more prevalent among patients undergoing resection of LuM and PM than LiM but do not affect survival after lung and peritoneal metastasectomy, as they do after hepatectomy. These results suggest that the prognostic significance of RAS mutations after resection of metastatic CRC depends on the specific site of metastases.
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Affiliation(s)
- Guillaume Passot
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Surgical Oncology, Hospices Civils de Lyon, CH Lyon Sud, EMR 37-38 University Lyon 1, Lyon, France
| | - Bradford J Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Olivier Glehen
- Department of Surgical Oncology, Hospices Civils de Lyon, CH Lyon Sud, EMR 37-38 University Lyon 1, Lyon, France
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Scott E Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Goere
- Department of Surgical Oncology, CLCC Institut Gustave Roussy, Villejuif, France
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc Pocard
- Department of General Surgery and Surgical Oncology, Assistance Publique des Hopitaux de Paris, Paris, France
| | - Frédéric Marchal
- Department of Surgical Oncology, Lorraine Cancer Institute, Vandoeuvre-les-Nancy, France
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Robinson JR, Newcomb PA, Hardikar S, Cohen SA, Phipps AI. Stage IV colorectal cancer primary site and patterns of distant metastasis. Cancer Epidemiol 2017; 48:92-95. [PMID: 28437692 DOI: 10.1016/j.canep.2017.04.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/02/2017] [Accepted: 04/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although colorectal cancer (CRC) usually metastasizes to the liver and/or lungs, factors influencing the anatomic pattern of metastases remain poorly understood. METHODS We assessed the relationship between primary CRC site and pattern of synchronous metastasis among 1202 individuals diagnosed with incident metastatic CRC between 2010 and 2014 and identified through the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) registry. Polytomous logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between primary tumor site and synchronous metastatic pattern. RESULTS Compared to patients with proximal colon primaries, patients with rectal primaries were more likely to present with lungs-only or liver and lungs metastases versus liver-only metastases (ORlungs-onlyvs.liver-only: 2.39, 95% CI: 1.35-4.24, ORliver+lungsvs.liver-only: 2.20, 95% CI: 1.46-3.32). CONCLUSION These findings suggest that patients with rectal primaries are more likely than patients with colon primaries to present with synchronous lung metastases.
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Affiliation(s)
- Jamaica R Robinson
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle WA, 98109, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St., Health Sciences Building, F-262, Seattle, WA, 98195, USA.
| | - Polly A Newcomb
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle WA, 98109, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St., Health Sciences Building, F-262, Seattle, WA, 98195, USA.
| | - Sheetal Hardikar
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle WA, 98109, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St., Health Sciences Building, F-262, Seattle, WA, 98195, USA.
| | - Stacey A Cohen
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle WA, 98109, USA; Department of Medicine, University of Washington, 1959 NE Pacific St., Health Sciences Building, RR-512, Seattle, WA, 98195, USA.
| | - Amanda I Phipps
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle WA, 98109, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St., Health Sciences Building, F-262, Seattle, WA, 98195, USA.
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Moorcraft SY, Jones T, Walker BA, Ladas G, Kalaitzaki E, Yuan L, Begum R, Eltahir Z, Wotherspoon A, Montero-Fernandez A, Teixeira Mendes LS, Gonzalez de Castro D, Wilson SH, Proszek P, To YM, Hawkes E, Roy A, Cunningham D, Rao S, Watkins D, Starling N, Bowcock AM, Chau I. Molecular profiling of colorectal pulmonary metastases and primary tumours: implications for targeted treatment. Oncotarget 2017; 8:64999-65008. [PMID: 29029407 PMCID: PMC5630307 DOI: 10.18632/oncotarget.17048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/29/2017] [Indexed: 12/29/2022] Open
Abstract
This study aimed to molecularly characterise colorectal pulmonary metastases (PM) and investigate whether their molecular profiles were concordant with those of the primary tumour. Clinical data and archival formalin fixed paraffin embedded tissue samples were retrospectively collected from patients who underwent ≥ 1 pulmonary metastasectomies for colorectal cancer between 1997–2012. Primary tumour and metastatic samples were analysed using a targeted capture sequencing panel of 46 cancer-associated genes. The 5-year progression-free and overall survival rates for the 81 patients in this study were 32% (95% CI 22–42%) and 77% (95% CI 66–85%) respectively. Fifty-four patients had samples available from ≥ 1 PM, and sequencing data were successfully obtained from 33 PM from 24 patients. The most frequently mutated genes were APC (71%), KRAS (58%) and TP53 (46%). Seventy-three percent of the 15 patients with matched primary and PM samples and 6 of the 7 patients (86%) with data from ≥ 2 PM had concordant molecular profiles. The concordance for KRAS and NRAS was 100%. At our institutions, patients with resectable colorectal PM had a favourable prognosis. RAS mutations were commonly detected in PM and the molecular profiles of colorectal PM were highly concordant with the primary tumour.
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Affiliation(s)
- Sing Y Moorcraft
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Thomas Jones
- The Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Brian A Walker
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - George Ladas
- The Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | - Lina Yuan
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Ruwaida Begum
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Zakaria Eltahir
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Andrew Wotherspoon
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | | | | | | | | | - Paula Proszek
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Ye M To
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Eliza Hawkes
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Amitesh Roy
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David Cunningham
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Sheela Rao
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David Watkins
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Naureen Starling
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Anne M Bowcock
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ian Chau
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
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Li P, Xiao Z, Braciak TA, Ou Q, Chen G, Oduncu FS. A relationship to survival is seen by combining the factors of mismatch repair status, tumor location and age of onset in colorectal cancer patients. PLoS One 2017; 12:e0172799. [PMID: 28253296 PMCID: PMC5333840 DOI: 10.1371/journal.pone.0172799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/16/2017] [Indexed: 01/29/2023] Open
Abstract
Background The progression of colorectal cancer (CRC) may differ depending on the location of the tumor and the age of onset of the disease. Previous studies also suggested that the molecular basis of CRC varies with tumor location, which could affect the clinical management of patients. Therefore, we performed survival analysis looking at different age groups and mismatch repair status (MMR) of CRC patients according to primary tumor location in an attempt to identify subgroups of CRC that might help in the prognosis of disease. Methods A group of 2233 patients operated on to remove their CRC tumors were analyzed (521 with right colon cancer, 740 with left colon cancer and 972 with rectal cancer). The expression of four MMR genes was assessed by immunohistochemistry (IHC), independent of clinical criteria. From the data collected, a predictive model for overall survival (OS) could be constructed for some associations of tumor location and age of onset using Kaplan-Meier, logistic and Cox regression analysis. Results When tumor location was considered as the lone factor, we found no statistical difference in overall survival (OS) between right cancer (68%), left cancer (67%) or rectal cancer tumor locations (71%) (HR: 1.17, 95%CI (confidence interval): 0.97–1.43, P = 0.057). When age of onset was considered, middle age (40–59 years) and older (60–85 years) patients were found to have higher OS than younger onset cancer (20–39 years) patients (69% vs 71% vs 59%, HR: 1.07, 95% confidence interval (CI): 0.91–1.25, P = 0.008). When both age of onset and tumor location were considered in combination as disease factors, we found that the subgroup of patients with left colon cancer from middle age (69%) and older (67%) aged patients had higher OS than younger (54%) patients (HR: 0.89, 95%CI: 0.68–1.16, P = 0.048). However in patients with right colon cancers, we found no statistical difference is OS between younger, middle age or older grouped patients (60% vs 71% vs 67%, HR: 0.84, 95% CI: 0.61–1.16, P = 0.194). With regard to rectal located cancers, we found that younger (62%) and middle age (68) patients had lower OS than older (77%) patients (HR:1.46, 95%CI: 1.13–1.88, P = 0.004). The rates of deficient MMR (dMMR) was 10.4%. We found no statistical difference in OS stratified by tumor locations. However, right colon cancer patients with dMMR (86%) had higher OS than those with proficient MMR (pMMR) (63%) (HR: 3.01, 95% CI: 1.82–4.97, P<0.001). Left colon cancer patients with dMMR (76%) also had higher OS than those with pMMR (66%) (HR: 1.67, 95% CI: 0.95–2.92, P = 0.01). Oppositely, rectal cancer patients with dMMR (60%) had lower OS than those pMMR (68%) (HR: 0.77, 95% CI: 0.51–1.17, P = 0.04). Conclusions These data demonstrate that primary tumor location can be an important factor when considered along with age of onset for the prognosis of CRC. Primary tumor location is also an important factor to evaluate the predictive effect of MMR status for the prognosis of CRC.
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Affiliation(s)
- Pan Li
- Department of Hematology and Oncology, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
| | - Zhitao Xiao
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Todd A. Braciak
- Department of Hematology and Oncology, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
| | - Qingjian Ou
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Gong Chen
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
- * E-mail: (GC); (FSO)
| | - Fuat S. Oduncu
- Department of Hematology and Oncology, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
- * E-mail: (GC); (FSO)
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Barone M, Prioletta M, Di Nuzzo D, Cipollone G, Camplese P, Mucilli F. Pulmonary metastasectomy in elderly colorectal cancer patients: a retrospective single center study. Updates Surg 2016; 68:357-67. [DOI: 10.1007/s13304-016-0399-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/19/2016] [Indexed: 12/20/2022]
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Eriksson O, Asplund A, Hegde G, Edqvist PH, Navani S, Pontén F, Siegbahn A. A stromal cell population in the large intestine identified by tissue factor expression that is lost during colorectal cancer progression. Thromb Haemost 2016; 116:1050-1059. [PMID: 27656710 DOI: 10.1160/th16-04-0267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/07/2016] [Indexed: 01/27/2023]
Abstract
Colorectal cancer (CRC) is a major cause of morbidity and mortality, and the composition of the tumour stroma is a strong predictor of survival in this cancer type. Tissue factor (TF) functions as the trigger of haemostasis together with its ligand coagulation factor VII/VIIa, and TF expression has been found in tumour cells of colorectal tumours. However, TF expression in the CRC tumour stroma or its relationship to patient outcome has not yet been studied. To address this question we developed and validated a specific anti-TF antibody using standardised methods within the Human Protein Atlas project. We used this antibody to investigate TF expression in normal colorectal tissue and CRC using immunofluorescence and immunohistochemistry in two patient cohorts. TF was strongly expressed in a cell population immediately adjacent to the colorectal epithelium. These TF-positive cells were ACTA2-negative but weakly vimentin-positive, defining a specific population of pericryptal sheath cells. In colorectal tumours, TF-positive sheath cells were progressively lost after the adenoma-to-carcinoma transition, demonstrating downregulation of this source of TF in CRC. Furthermore, loss of sheath cell TF was significantly associated with poor overall and disease-specific survival in rectal but not colon cancers. In conclusion, we demonstrate that TF is a marker of a specific cell population in the large intestine, which is lost during CRC progression. Our results highlight the role of the tumour stroma in this cancer type and suggest TF to be a potential prognostic biomarker in rectal cancers through the identification of pericryptal sheath cells.
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Affiliation(s)
- Oskar Eriksson
- Oskar Eriksson, Department of Medical Sciences, Clinical Chemistry, University Hospital, Entr. 61, 3rd floor, S-751 85 Uppsala, Sweden, Tel.: +46 186114251, Fax: +46 18552562, E-mail:
| | | | | | | | | | | | - Agneta Siegbahn
- Agneta Siegbahn, Department of Medical Sciences, Clinical Chemistry, University Hospital, Entr. 61, 3rd floor, S-751 85 Uppsala, Sweden, Tel.: +46 186114251, Fax: +46 18552562, E-mail:
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Patel D, Townsend AR, Karapetis C, Beeke C, Padbury R, Roy A, Maddern G, Roder D, Price TJ. Is Survival for Patients with Resectable Lung Metastatic Colorectal Cancer Comparable to Those with Resectable Liver Disease? Results from the South Australian Metastatic Colorectal Registry. Ann Surg Oncol 2016; 23:3616-3622. [PMID: 27251133 DOI: 10.1245/s10434-016-5290-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatic resection for colorectal (CRC) metastasis is considered a standard of care. Resection of metastasis isolated to lung also is considered potentially curable, although there is still some variation in recommendations. We explore outcomes for patients undergoing lung resection for mCRC, with the liver resection group as the comparator. METHODS South Australian (SA) metastatic CRC registry data were analysed to assess patient characteristics and survival outcomes for patients suitable for lung or liver resection. RESULTS A total of 3241 patients are registered on the database to December 2014. One hundred two (3.1 %) patients were able to undergo a lung resection compared with 420 (12.9 %) who had a liver resection. Of the lung resection patients, 62 (61 %) presented with lung disease only, 21 % initially presented with liver disease only, 11 % had both lung and liver, and 7 % had brain or pelvic disease resection. Of these patients, 79 % went straight to surgery without any neoadjuvant treatment and 34 % had lung resection as the only intervention. Chemotherapy for metastatic disease was given more often to liver resection patients: 76.9 versus 53.9 %, p = 0.17. Median overall survival is 5.6 years for liver resection and has not been reached for lung resection (hazard ratio 0.82, 95 % confidence interval 0.54-1.24, p = 0.33). CONCLUSIONS Lung resection was undertaken in 3.1 % of patients with mCRC in our registry. These data provide further support for long-term survival after lung resection in mCRC, survival that is at least comparable to those who undergo resection for liver metastasis in mCRC.
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Affiliation(s)
- Dainik Patel
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Amanda R Townsend
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Christos Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia.,Flinders University, Adelaide, SA, Australia
| | - Carol Beeke
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia.,Flinders University, Adelaide, SA, Australia
| | - Rob Padbury
- Department of Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Amitesh Roy
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia.,Flinders University, Adelaide, SA, Australia
| | - Guy Maddern
- Department of Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - David Roder
- Department of Epidemiology, University of South Australia, Adelaide, SA, Australia
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia. .,University of Adelaide, Adelaide, SA, Australia.
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Pugh SA, Shinkins B, Fuller A, Mellor J, Mant D, Primrose JN. Site and Stage of Colorectal Cancer Influence the Likelihood and Distribution of Disease Recurrence and Postrecurrence Survival: Data From the FACS Randomized Controlled Trial. Ann Surg 2016; 263:1143-7. [PMID: 26135689 DOI: 10.1097/sla.0000000000001351] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To describe patterns of recurrence and postrecurrence survival in a large cohort of accurately staged patients with Dukes' A-C colorectal cancer. BACKGROUND Recurrence remains a frequent cause of mortality after the treatment of colorectal cancer with curative intent. Understanding the likelihood and site of recurrence informs adjuvant treatment and follow-up. METHODS Retrospective cohort analysis of data from the FACS (follow-up after colorectal cancer surgery) trial after a median 4.4 years of follow-up; postrecurrence survival was calculated using the Kaplan-Meier method. RESULTS Complete data were available for 94% of patients; 189 (17%) patients had experienced recurrence. Incidence of recurrence varied according to the site of the primary (right colon: 51/379, 14%; left colon: 68/421, 16%; rectum: 70/332, 21%; P = 0.023) and initial stage (Dukes' A: 26/249, 10%; Dukes' B: 81/537, 15%; Dukes' C: 82/346, 24%; P < 0.0001). Pulmonary recurrence was most frequently associated with rectal tumors, and multisite/other recurrence with right-sided colonic tumors. Recurrences from lower-stage tumors were more likely to be treatable with curative intent (Dukes' A: 13/26, 50%; Dukes' B: 32/81, 40%; Dukes' C: 20/82, 24%; P = 0.03). Those with rectal tumors benefited most from follow-up (proportion with treatable recurrence: rectum 30/332, 9%; left colon 23/421, 6%; right colon 12/379, 3%; P = 0.003). Both initial stage (log rank P = 0.005) and site of primary (log rank P = 0.01) influenced postrecurrence survival. CONCLUSIONS The likelihood and site of recurrence, and survival, are influenced by the site and stage of the primary tumor. Those with rectal cancers benefited most from follow-up.ISRCTN 41458548.
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Affiliation(s)
- Siân A Pugh
- *University Surgery, University of Southampton, Southampton, United Kingdom†Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom‡Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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Fielli M, Avila F, Saino A, Seimah D, Fernández Casares M. Diffuse cystic lung disease due to pulmonary metastasis of colorectal carcinoma. Respir Med Case Rep 2016; 17:83-5. [PMID: 27222791 PMCID: PMC4821331 DOI: 10.1016/j.rmcr.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 11/15/2022] Open
Abstract
The diffuse cystic lung diseases (DCLDs) are a pathophysiologically heterogeneous processes characterized by the presence of multiple thin-walled, air-filled spaces within the pulmonary parenchyma. The most common causes of DCLD are lymphangioleiomyomatosis (LAM) and pulmonary Langerhans cell histiocytosis (PLCH). DCLD develops rarely as a result of malignancy, typically secondary to metastases from peripheral sarcomas and mesenchymal tumors. DCLD have also been reported in a variety of other metastatic disease such as adenocarcinoma. Our case describes a patient with DCLD as a result of metastatic colorectal adenocarcinoma.
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Affiliation(s)
- Mariano Fielli
- Pulmonary Section, Department of Internal Medicine, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Fabio Avila
- Pulmonary Section, Department of Internal Medicine, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Agustina Saino
- Pathology Department, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Deborah Seimah
- Pathology Department, Hospital Nacional Posadas, Buenos Aires, Argentina
| | - Marcelo Fernández Casares
- Pulmonary Section, Department of Internal Medicine, Hospital Nacional Posadas, Buenos Aires, Argentina
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Moorcraft SY, Ladas G, Bowcock A, Chau I. Management of resectable colorectal lung metastases. Clin Exp Metastasis 2016; 33:285-96. [DOI: 10.1007/s10585-015-9774-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
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Vatandoust S, Price TJ, Karapetis CS. Colorectal cancer: Metastases to a single organ. World J Gastroenterol 2015; 21:11767-11776. [PMID: 26557001 PMCID: PMC4631975 DOI: 10.3748/wjg.v21.i41.11767] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/20/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is a common malignancy worldwide. In CRC patients, metastases are the main cause of cancer-related mortality. In a group of metastatic CRC patients, the metastases are limited to a single site (solitary organ); the liver and lungs are the most commonly involved sites. When metastatic disease is limited to the liver and/or lungs, the resectability of the metastatic lesions will dictate the management approach and the outcome. Less commonly, the site of solitary organ CRC metastasis is the peritoneum. In these patients, cytoreduction followed by hyperthermic intraperitoneal chemotherapy may improve the outcome. Rarely, CRC involves other organs, such as the brain, bone, adrenals and spleen, as the only site of metastatic disease. There are limited data to guide clinical practice in these cases. Here, we have reviewed the disease characteristics, management approaches and prognosis based on the metastatic disease site in patients with CRC with metastases to a single organ.
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Augestad K, Bakaki P, Rose J, Crawshaw B, Lindsetmo R, Dørum L, Koroukian S, Delaney C. Metastatic spread pattern after curative colorectal cancer surgery. A retrospective, longitudinal analysis. Cancer Epidemiol 2015; 39:734-44. [DOI: 10.1016/j.canep.2015.07.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/19/2015] [Accepted: 07/21/2015] [Indexed: 01/05/2023]
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Ma K, Nayak S, Li H, Evans K, Francescatti A, Brand MI, Orkin B, Hill M, Cameron J, Mobarhan S, Favuzza J, Melson J. Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty. Gastrointest Endosc 2015; 82:497-502. [PMID: 25910667 DOI: 10.1016/j.gie.2015.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/05/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since 2008, multiple guidelines have endorsed incorporation of chest CT in the radiographic staging assessment of newly diagnosed colorectal cancer (CRC). Radiographic staging practices performed after CRC is detected have not been studied. OBJECTIVE To evaluate radiographic staging practices for newly diagnosed CRC between gastroenterologists versus non-gastroenterologists. DESIGN Observational cohort study. SETTING Single, tertiary-care referral center. PATIENTS Patients newly diagnosed with a T1 or higher stage CRC at time of colonoscopy between 2008 and 2013. INTERVENTIONS Radiographic staging. MAIN OUTCOME MEASUREMENTS Radiographic preoperative staging examinations ordered by gastroenterologists in comparison to those ordered by non-gastroenterology specialists. RESULTS This study included 277 patients with CRC newly diagnosed by colonoscopy. There were 141 total ordering physicians (68 gastroenterologists and 73 non-gastroenterologists). The majority of preoperative radiographic staging was performed by gastroenterologists (59.2% of patients, n = 164). Colorectal surgeons managed staging in 28.7% of patients (n = 47). Gastroenterologists were more likely to omit a staging chest CT than were non-gastroenterologists (64.6% vs 46.9%; P < .001). Physician practice setting, rectal location of tumor, and advanced endoscopic appearance of tumors were predictors of chest CT inclusion. LIMITATIONS Single center, moderate sample size of both providers and patients. CONCLUSION Gastroenterologists more frequently ordered the initial radiographic staging studies in newly diagnosed CRC patients. However, gastroenterologists were less likely to include chest CT in the initial staging of CRC despite current guideline recommendations to do so. If confirmed with further studies, educational efforts to improve compliance and standardization may be needed.
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Shapiro M, Rashid NU, Whang EE, Boosalis VA, Huang Q, Yoon C, Saund MS, Gold JS. Trends and predictors of resection of the primary tumor for patients with stage IV colorectal cancer. J Surg Oncol 2015; 111:911-6. [PMID: 25919984 DOI: 10.1002/jso.23906] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/28/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Over 130,000 patients are diagnosed with colorectal cancer annually, with approximately 20% presenting with unresectable metastatic disease. Recent consensus guidelines recommend against primary tumor resection for asymptomatic patients with unresectable metastases. Our goal was to examine the trends and predictors of surgical resection. METHODS Cases of colorectal cancer with synchronous metastases diagnosed between 1988-2010 were identified using the Surveillance, Epidemiology and End Results (SEER) Database. Associations between resection and clinicopathologic variables were sought using univariate and multivariate logistic regression. RESULTS Overall, 68% of patients with synchronous metastatic colorectal cancer underwent primary tumor resection. Resection rates were as high as 76% in the earliest time period (1988-1992) and steadily dropped to 60% in the most recent period (2008-2010). Socioeconomic factors associated with resection on univariate analysis included age, race, gender, marital status, insurance status, and geographic region. Clinicopathologic characteristics associated with resection included tumor location, grade, size, and CEA level. In the multivariate model, gender, geographic region, insurance status, tumor location, grade and CEA level were independent predictors of primary tumor resection. CONCLUSIONS Surgical resection of the primary site remains common practice for patients with synchronous metastatic colorectal cancer. Treatment disparities are associated with socioeconomic as well as clinicopathologic factors.
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Affiliation(s)
- Mia Shapiro
- Surgery Services, VA Boston Healthcare System, Harvard Medical School, West Roxbury, Massachusetts; VA Boston Healthcare System, Harvard Medical School, West Roxbury, Massachusetts
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Abstract
Imaging in rectal cancer has a vital role in staging disease, and in selecting and optimizing treatment planning. High-resolution MRI (HR-MRI) is the recommended method of first choice for local staging of rectal cancer for both primary staging and for restaging after preoperative chemoradiation (CT-RT). HR-MRI helps decide between upfront surgery and preoperative CT-RT. It provides high accuracy for prediction of circumferential resection margin at surgery, T category, and nodal status in that order. MRI also helps assess resectability after preoperative CT-RT and decide between sphincter saving or more radical surgery. Accurate technique is crucial for obtaining high-resolution images in the appropriate planes for correct staging. The phased array external coil has replaced the endorectal coil that is no longer recommended. Non-fat suppressed 2D T2-weighted (T2W) sequences in orthogonal planes to the tumor are sufficient for primary staging. Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging. Diffusion-weighted sequence may be of value in restaging. Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases. Positron emission tomography-computed tomography (PET/CT) has a limited role in the initial staging of rectal cancer and is reserved for cases with resectable metastatic disease before contemplating surgery. This article briefly reviews the comprehensive role of imaging in rectal cancer, describes the role of MRI in local staging in detail, discusses the optimal MRI technique, and provides a synoptic report for both primary staging and restaging after CT-RT in routine practice.
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Affiliation(s)
- Supreeta Arya
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deepak Das
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Tilly C, Lefèvre JH, Svrcek M, Shields C, Fléjou JF, Tiret E, Parc Y. R1 rectal resection: look up and don't look down. Ann Surg 2014; 260:794-9; discussion 799-800. [PMID: 25379851 DOI: 10.1097/SLA.0000000000000988] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND After rectal resection for adenocarcinoma, pathological examination may reveal invasion of the distal margin (DM) and/or a circumferential resection margin of the tumor (CRM-T) or of involved nodes (CRM-N) less than or equal to 1 mm. Such findings transform a planned R0 resection to R1. AIM : The aim was to analyze the impact of an R1 resection on prognosis, recurrence rate, and choice of adjuvant treatment. PATIENTS AND METHODS All R1 resections observed between 2006 and 2011 were retrospectively collected. Patients were matched with 80 patients with R0 resections according to age, body mass index, gender, neoadjuvant treatment, type of resection, ypT/pT stages, and N stage. RESULTS Among 472 rectal resections performed, 40 (8.5%) were R1 (CRM-T=34; CRM-N=11; invaded DM=4). Among the 4 patients with invaded DM, 3 underwent salvage abdominoperineal resection. Of the 12 patients who had not received neoadjuvant treatment, 5 received adjuvant radiotherapy. Mean follow-up was 49.3±29.3 months for the 120 patients; 5-year overall survival (OS) and disease-free survival (DFS) were 72% and 56%. Comparison between R0 and R1 resections showed a trend toward worse OS in R1 resections: 62% versus 79% (P=0.0954), a significantly worse DFS: 41% versus 65% (P=0.0267). Local recurrence rates were similar: 12% versus 13% (P=0.9177), whereas distant recurrence was significantly more frequent after R1 resection: 56% versus 26% (P=0.0040). CONCLUSIONS R1 resection is associated with a worse prognosis, but local recurrence rate does not differ significantly from matched R0 resections. The difference was observed for distant recurrences, especially lung, favoring the use of chemotherapy and close surveillance of the thorax.
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