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Jiménez-Fonseca P, Sastre J, García-Alfonso P, Gómez-España MA, Salud A, Gil S, Rivera F, Reina JJ, Quintero G, Valladares-Ayerbes M, Safont MJ, La Casta A, Robles-Díaz L, García-Paredes B, López López R, Guillot M, Gallego J, Alonso-Orduña V, Diaz-Rubio E, Aranda E. Association of Circulating Tumor Cells and Tumor Molecular Profile With Clinical Outcomes in Patients With Previously Untreated Metastatic Colorectal Cancer: A Pooled Analysis of the Phase III VISNÚ-1 and Phase II VISNÚ-2 Randomized Trials. Clin Colorectal Cancer 2023; 22:222-230. [PMID: 36944559 DOI: 10.1016/j.clcc.2023.02.004] [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: 04/06/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The bCTC count is a well-established prognostic biomarker in mCRC, as well as in other tumor types. The aim of this analysis was to evaluate the prognostic/predictive role of the bCTC count (≥3 vs. <3) in previously untreated mCRC. PATIENTS AND METHODS The study involved 589 untreated mCRC patients included in the intention-to-treat population of 2 randomized clinical trials (phase III VISNU-1 [NCT01640405] and phase II VISNU-2 [NCT01640444] studies). RESULTS Of the 589 patients, 349 (59.2%) had bCTC≥3 and 240 (40.7%) had bCTC<3. Multivariate analysis showed that the bCTC count is an independent prognostic factor for overall survival (OS) (HR 0.59, 95% CI 0.48-0.72; P = 0.000) and potential for progression-free survival (PFS) (P = 0.0549). Median OS was 32.9 and 19.5 months in patients with bCTC<3 and bCTC≥3 (P <0.001), respectively. This effect was also observed comparing OS in RASwt patients from both studies. Other prognostic factors were: ECOG-PS, primary tumor site, number of metastatic sites and surgery of the primary tumor. Median OS was lower for patients treated with anti-VEGF versus anti-EGFR (22.3 vs. 33.3 months, P <0.0001) while there were no significant differences in PFS according to the targeted treatment received. CONCLUSION This post-hoc analysis of 2 randomized studies confirms the poor prognosis of patients with bCTC≥3 but this is not associated with other adverse independent prognostic factors such as RAS/BRAF mutations.
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Affiliation(s)
- P Jiménez-Fonseca
- Department of Medical Oncology. Hospital Universitario Central de Asturias, ISPA, Oviedo, 33011, Spain.
| | - J Sastre
- Department of Medical Oncology. Hospital Clínico San Carlos. Instituto de Investigación Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, 28040, Spain
| | - P García-Alfonso
- Department of Medical Oncology, Hospital Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - M A Gómez-España
- Department of Medical Oncology. Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBERONC, Instituto de Salud Carlos III, Córdoba, 14004, Spain
| | - A Salud
- Department of Medical Oncology, Hospital Universitario Arnau de Vilanova, Lérida, 25198, Spain
| | - S Gil
- Department of Medical Oncology. Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, 29010, Spain
| | - F Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, 39008, Spain
| | - J J Reina
- Department of Medical Oncology, Complejo Hospitalario Virgen de la Macarena, Sevilla, 41009, Spain
| | - G Quintero
- Department of Medical Oncology, Hospital Universitario Lucus Augusti, Lugo, 27003, Spain
| | - M Valladares-Ayerbes
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Sevilla, 41013, Spain
| | - M J Safont
- Department of Medical Oncology, Hospital General Universitario de Valencia, CIBERONC, Universidad de Valencia, Valencia, 46014, Spain
| | - A La Casta
- Department of Medical Oncology, Hospital de Donostia, Guipúzcoa, 20014, Spain
| | - L Robles-Díaz
- Department of Medical Oncology. Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
| | - B García-Paredes
- Department of Medical Oncology. Hospital Clínico San Carlos. Instituto de Investigación Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, 28040, Spain
| | - R López López
- Department of Medical Oncology and Translational Medical Oncology Group. Hospital Universitario Santiago de Compostela and Health Research Institute (IDIS), CIBERONC, Santiago de Compostela, 15706, Spain
| | - M Guillot
- Department of Medical Oncology. Hospital Universitario Son Espases, Palma de Mallorca, 07120, Spain
| | - J Gallego
- Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, 03203, Spain
| | - V Alonso-Orduña
- Department of Medical Oncology, Hospital Universitario Miguel Servet. Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, 50009, Spain
| | - E Diaz-Rubio
- Department of Medical Oncology. Hospital Clínico San Carlos. Instituto de Investigación Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, 28040, Spain
| | - E Aranda
- Department of Medical Oncology. Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBERONC, Instituto de Salud Carlos III, Córdoba, 14004, Spain
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García-Alfonso P, Reina Zoilo J, Mata Velasco E, Llanos M, Illán Varella A, Safont Aguilera M, Delgado Ureña M, Castañón C, Pimentel P, Alonso Orduña V, Mendez J, Rivera Herrero F, Siso I, Rodriguez-Pascual J, Grávalos Castro C, Afonso R, Fernandez Rañada I, Grández R, Moreno M, López Muñoz A, García-Paredes B, Aranda E. P-50 Prognostic factors in patients receiving trifluridine/tipiracil for refractory metastatic colorectal cancer in the real-life setting: The ROS study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Valladares-Ayerbes M, Toledano Fonseca M, Vieitez de Prado J, Inga-Saavedra E, Gil S, Graña Suarez B, García-Paredes B, Salud A, Rivera Herrero F, Salgado Fernandez M, García-Alfonso P, López-López R, Ferreiro Monteagudo R, Sastre J, Diaz-Rubio E, Aranda E. P-99 Circulating RNA detection, circulating tumor cells count, and molecular tumor profiling in a cohort of untreated metastatic colorectal cancer: A prospective multicenter ancillary study to the randomized VISNÚ trials. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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4
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Sastre J, García-Alfonso P, Viéitez JM, Cano MT, Rivera F, Reina-Zoilo JJ, Salud-Salvia A, Quintero G, Robles-Díaz L, Safont MJ, La Casta A, Gil S, Polo E, Asensio-Martínez E, García-Paredes B, López RL, Guillot M, Valladares-Ayerbes M, Aranda E, Díaz-Rubio E. Influence of BRAF and PIK3CA mutations on the efficacy of FOLFIRI plus bevacizumab or cetuximab as first-line therapy in patients with RAS wild-type metastatic colorectal carcinoma and <3 baseline circulating tumour cells: the randomised phase II VISNÚ-2 study. ESMO Open 2021; 6:100062. [PMID: 33711671 PMCID: PMC7970062 DOI: 10.1016/j.esmoop.2021.100062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/26/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 01/09/2023] Open
Abstract
Background We explored the influence of BRAF and PIK3CA mutational status on the efficacy of bevacizumab or cetuximab plus 5-fluorouracil/leucovorin and irinotecan (FOLFIRI) as first-line therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC). Patients and methods VISNÚ-2 was a multicentre, randomised, phase II study. Patients with RAS wild-type mCRC and <3 circulating tumour cells/7.5 ml blood were stratified by BRAF/PIK3CA status (wild-type versus mutated) and number of affected organs (1 versus >1), and allocated to bevacizumab (5 mg/kg every 2 weeks) or cetuximab (400 mg/m2 then 250 mg/m2 weekly) plus FOLFIRI [irinotecan 180 mg/m2, leucovorin 400 mg/m2, 5-fluorouracil 400 mg/m2 (bolus) then 2400 mg/m2 (46-h continuous infusion) every 2 weeks]. The primary endpoint was progression-free survival (PFS). All analyses were exploratory. Results Two hundred and forty patients with BRAF/PIK3CA wild-type (n = 196) or BRAF- and/or PIK3CA-mutated tumours (n = 44) were enrolled. Median PFS was 12.7 and 8.8 months in patients with BRAF/PIK3CA wild-type and BRAF/PIK3CA-mutated tumours, respectively [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.80-1.85; P = 0.3602]. In the BRAF- and/or PIK3CA-mutated cohort, median PFS was 2.8, 8.8 and 15.0 months in patients with BRAF/PI3KCA-mutated (n = 8), BRAF-mutated/PI3KCA wild-type (n = 16) and BRAF wild-type/PI3KCA-mutated (n = 20) tumours, respectively (P = 0.0002). PFS was similar with bevacizumab plus FOLFIRI versus cetuximab plus FOLFIRI in BRAF/PIK3CA wild-type (HR = 0.99; 95% CI 0.67-1.45; P = 0.9486) and BRAF/PIK3CA-mutated tumours (HR = 1.11; 95% CI 0.53-2.35; P = 0.7820). The most common grade 3/4 treatment-related adverse events were neutropenia, diarrhoea and asthenia in both treatment groups. Conclusions BRAF/PIK3CA status influences outcomes in patients with RAS wild-type mCRC but does not appear to assist with the selection of first-line targeted therapy. This study examined if BRAF/PIK3CA mutational status can guide therapy in RAS wild-type mCRC. BRAF mutations were associated with poorer survival outcomes, and were potentiated by PI3KCA mutations. Bevacizumab-FOLFIRI versus cetuximab-FOLFIRI had similar outcomes in BRAF /PIK3CA wild-type and BRAF /PIK3CA-mutated tumours. BRAF and PI3KCA mutations have a role as prognostic but not predictive factors.
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Affiliation(s)
- J Sastre
- Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.
| | - P García-Alfonso
- Medical Oncology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J M Viéitez
- Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M T Cano
- Medical Oncology, IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Cordoba, Spain
| | - F Rivera
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - J J Reina-Zoilo
- Medical Oncology, Complejo Hospitalario Virgen de la Macarena, Seville, Spain
| | - A Salud-Salvia
- Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | - G Quintero
- Medical Oncology, Hospital Lucus Augusti, Lugo, Spain
| | - L Robles-Díaz
- Medical Oncology, Hospital 12 de Octubre, Madrid, Spain
| | - M J Safont
- Medical Oncology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A La Casta
- Medical Oncology, Hospital de Donostia, Guipúzcoa, Spain
| | - S Gil
- Medical Oncology, Hospital Universitario Regional y Virgen de la Victoria, Malaga, Spain
| | - E Polo
- Medical Oncology, Hospital Miguel Servet, Zaragoza, Spain
| | - E Asensio-Martínez
- Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain
| | - B García-Paredes
- Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - R L López
- Medical Oncology, University Clinical Hospital and Health Research Institute (IDIS), CIBERONC, Santiago de Compostela University School of Medicine, Santiago de Compostela, Spain
| | - M Guillot
- Medical Oncology, Hospital Son Espases, Palma de Mallorca, Spain
| | - M Valladares-Ayerbes
- Medical Oncology, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica (INIBIC), A Coruña, Spain
| | - E Aranda
- Medical Oncology, IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Cordoba, Spain
| | - E Díaz-Rubio
- Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
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Martín M, de la Torre-Montero JC, López-Tarruella S, Pinilla K, Casado A, Fernandez S, Jerez Y, Puente J, Palomero I, González Del Val R, Del Monte-Millan M, Massarrah T, Vila C, García-Paredes B, García-Sáenz JA, Lluch A. Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling. Breast Cancer Res Treat 2018; 171:627-634. [PMID: 29923063 PMCID: PMC6133184 DOI: 10.1007/s10549-018-4855-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
Background Persistent alopecia (PA) after docetaxel has been recently described. The aim of our study is to establish the incidence and characteristics of PA following adjuvant docetaxel for breast cancer (BC) and to test the ability of scalp cooling in prevention. Patients and methods BC patients receiving adjuvant chemotherapy followed or not by endocrine therapy (and a control group receiving only endocrine therapy) were interviewed in a single institution at 1.5 to 5 years following primary diagnosis searching for PA. A confirmatory prevalence study was later performed in other two institutions. Finally, a prevention study using prophylactic scalp cooling (PSC) with ELASTO-GEL hypothermia caps in patients receiving adjuvant docetaxel was performed. Results In the initial prevalence study (492 patients), minor forms of PA (grade 1) were recorded with all chemotherapy regimens and aromatase inhibitors. Patients receiving docetaxel regimens at cumulative dose (CD) ≥ 400 mmg/m2 presented a significantly higher prevalence of grades 1 PA (33–52%) and 2 PA (5–12%). Prevalence of grade 2 PA with docetaxel CD ≥ 400 mmg/m2 was confirmed in two other institutions. Overall, grade 2 PA was seen in 10.06% (95% CI 7.36–13.61) of 358 patients with docetaxel regimens reaching CD ≥ 400 mmg/m2, but not in patients with lower docetaxel CD, other chemotherapy regimens, or endocrine therapy alone. In prevention trial, no grade 2 PA occurred among 116 patients receiving adjuvant docetaxel (≥ 400 mmg/m2) and PSC followed-up after a 96 months median time. PSC was well tolerated. No scalp relapses were seen among 30 patients (22% of all inclusions) having disease relapse. Conclusion Adjuvant treatment with docetaxel (CD ≥ 400 mmg/m2) is associated with a significant rate of grade 2 PA, leading to wearing a wig, in around 10% of patients. This toxicity was completely prevented with scalp cooling. Clinical Trial Reference: NCT00515762. Electronic supplementary material The online version of this article (10.1007/s10549-018-4855-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain. .,Hospital General Universitario Gregorio Marañón, Medical Oncology Service, Calle Maiquez, no. 9, 28007, Madrid, Spain.
| | - J C de la Torre-Montero
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Universidad Pontificia Comillas, Madrid, Spain
| | - S López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - K Pinilla
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
| | - A Casado
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - S Fernandez
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Y Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - J Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - I Palomero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - R González Del Val
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - M Del Monte-Millan
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - T Massarrah
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - C Vila
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - B García-Paredes
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - J A García-Sáenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - A Lluch
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
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Gravalos C, Capdevila J, Layos L, Pericay C, Martínez-Villacampa M, López López C, Losa F, Safont M, Gómez-España A, Alonso V, Escudero P, Gallego J, García-Paredes B, Palacios A, Biondo S, Salazar R, Aranda Aguilar E. Phase II randomized trial of capecitabine + radiation therapy with/without bevacizumab as preoperative treatment for patients with resectable locally advanced rectal adenocarcinoma: Final results of 3 and 5-year disease free survival, distant relapse free survival and overall survival. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Argilés Martinez G, Sanz-Garcia E, Valladares-Ayerbes M, Viéitez J, Garcia-Alfonso P, Gravalos C, Tobeña M, Duran Ogaya G, Cano Osuna M, García-Paredes B, Santos C, Rodríguez-Garrote M, Rivera Herrero F, Safont M, Falcone A, Ciardiello F, Goldberg R, Bennouna J, Tabernero J, Aranda Aguilar E. A randomized Phase 2 study comparing different dosing approaches of induction treatment (first cycle) of regorafenib in metastatic colorectal cancer (mCRC) patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pericay C, Martínez-Lago N, Corral M, Macías Declara I, Donnay O, Juez Martel I, García-Paredes B, Méndez Méndez J, Cacho Lanvin D, González-Astorga B, Ruiz Casado A, Delgado Ureña M, Rodriguez N, Calderero Aragón V, Mata Velasco E, Barrera Ramírez J, Macarulla T. P-051 Preliminary clinical and pathologic characteristics of patients treated in second-line (2L) with 25 cycles (Cy) or more of FOLFIRI + Aflibercept (FA). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fernández-Aceñero MJ, Granja M, Sastre J, García-Paredes B, Estrada L. Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma. Virchows Arch 2016; 468:425-30. [PMID: 26754675 DOI: 10.1007/s00428-015-1901-x] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/08/2015] [Accepted: 12/29/2015] [Indexed: 12/13/2022]
Abstract
Neoadjuvant therapy (NAT) is mainly indicated for locally advanced rectal carcinoma. Many reports have shown that regression of the primary tumor is a prognostic factor. However, few reports to date have analyzed the potential prognostic significance of lymph node regression in rectal carcinoma. The aim of the present study is to describe the pattern of tumor regression in lymph nodes after NAT for rectal carcinoma and its potential prognostic significance. We have retrospectively reviewed 106 cases of rectal carcinoma treated at a single institution. We have retrieved data from the patients and reviewed the histopathological slides to evaluate tumor regression both of the primary tumor and of LN metastases. Prognosis has been defined both in terms of disease-free survival (DFS) and disease-specific survival (DSS). Of the patients, 16% showed complete response of the primary tumor, while 24% showed poor response, according to the CAP regression grading system. Absence of lymph node involvement after therapy was found in 80% of the patients (ypN0 cases), while 20% were ypN+. We reviewed 639 LN; 85 were involved by tumor, and 170 showed histological signs of tumor regression. The main pattern of tumor regression in lymph nodes was fibrosis (66.3%), followed by hystiocytosis (29.1%) and mucin pools (4.6%). We found histological signs of regression in 57% of ypN0 cases and 76% of ypN+ cases. We found a significant association between regression grade of the primary tumor and of lymph node metastases. For ypN0 patients with persistence of the primary tumor after NAT, the median DFS was significantly shorter in patients showing tumor regression in the LN. In a Cox multivariate survival model for DFS, this prognostic influence was independent of the regression grade of the primary tumor and also of the ypTNM stage. We found no significant association between any factor and DSS. The pattern of tumor regression in lymph nodes was not significantly associated with prognosis. Tumor regression in lymph nodes is an important prognostic factor in rectal carcinoma after NAT and should be specifically looked for and included in pathology reports.
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Affiliation(s)
- M J Fernández-Aceñero
- Surgical Pathology Department, Hospital Clínico San Carlos, Avda Profesor Lagos s/n 28040, Madrid, Spain.
| | - M Granja
- Department of Medical Oncology, Hospital Clínico San Carlos, Avda Profesor Lagos s/n 28040, Madrid, Spain
| | - J Sastre
- Department of Medical Oncology, Hospital Clínico San Carlos, Avda Profesor Lagos s/n 28040, Madrid, Spain
| | - B García-Paredes
- Department of Medical Oncology, Hospital Clínico San Carlos, Avda Profesor Lagos s/n 28040, Madrid, Spain
| | - L Estrada
- Surgical Pathology Department, Hospital Clínico San Carlos, Avda Profesor Lagos s/n 28040, Madrid, Spain
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Aranda E, García-Alfonso P, Benavides M, Sanchez-Ruiz A, Guillen-Ponce C, Safont M, Alcaide J, Gomez A, Lopez R, Manzano J, Mendez-Urena M, Lopez C, García-Paredes B, Grávalos C, García-García T, Falco E, Martin-Valades J, Gonzalez-Flores E, Navalon M, Diaz-Rubio E. 2122 Treatment outcomes according to extended RAS mutation testing in a phase II study of first-line mFOLFOX plus cetuximab followed by cetuximab in monotherapy as maintenance therapy or mFOLFOX plus cetuximab in patients with metastatic colorectal cancer: The MACRO-2 trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sotelo L, Sastre J, García-Paredes B, Cabezas-Camarero S, Vieitez J, Alonso V, Grávalos C, Escudero P, Vera R, Aranda E, García-Alfonso P, Gallego-Plazas J, Lopez C, Pericay C, Arrivi A, Vicente P, Ballesteros P, Elez E, Lopez-Ladron A, Diaz-Rubio E. 2033 Stage III colorectal cancer (CRC) in Spain: A retrospective analysis from 35 centres. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30956-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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García Alfonso P, Ortiz M, Durán G, Falcó E, Muñoz A, García-Paredes B, Salgado M, López-Ladrón A, Vieitez de Prado J, Valladares M, Salud A, Guillén-Ponce C, Lopez R, Robles L, Juárez A, Serrano S, Montagut C, Zanui M, Gil Raga M, La Casta A, Benavides M, Aranda E. P-272 Phase II study of Regorafenib as single agent for the treatment of patients with metastatic colorectal cancer with any RAS or BRAF mutation and previously treated with FOLFOXIRI plus bevacizumab. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Garre P, Martín L, Sanz J, Romero A, Tosar A, Bando I, Llovet P, Diaque P, García-Paredes B, Díaz-Rubio E, de la Hoya M, Caldés T. BRCA2 gene: a candidate for clinical testing in familial colorectal cancer type X. Clin Genet 2014; 87:582-7. [PMID: 24814045 DOI: 10.1111/cge.12427] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 02/26/2014] [Revised: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 01/19/2023]
Abstract
Familial colorectal cancer type X (FCCX) encompasses a group of families with dominant inheritance pattern of colorectal cancer (CRC) but no alteration in any known CRC susceptibility gene. Therefore, the explanation of their susceptibility is a priority to offer an accurate genetic counseling. We screened the 27 coding exons and exon-intron boundaries of BRCA2 in 48 FCCX probands. We identified 29 variants including a frameshift mutation. Deleterious variant c.3847_3848delGT p.(Val1283Lysfs*2) showed cosegregation with disease as well as loss of heterozygosity (LOH) in CRC tumor DNA. This is the first evidence of germline BRCA2 pathogenic mutation associated with CRC risk. Furthermore, missense variants c.502C>A p.(Pro168Thr), c.5744C>T p.(Thr1915Met) and c.7759C>T p.(Leu2587Phe) were proposed as candidate risk alleles based on cosegregation, LOH tumor analysis and in silico testing.
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Affiliation(s)
- P Garre
- Laboratorio de Oncología Molecular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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