Metastatic colo-rectal cancer: real life experience from an Indian tertiary care center

Abstract

Background No data exist for the long-term outcome of metastatic colorectal cancer (mCRC) from the Southern part of Asia. The primary objective of the study is to evaluate the survival outcome of mCRC from an Indian tertiary care center. The study also aims to highlight the treatment pattern practiced and the unique clinico-pathologic characteristics. Methods This is a single-center retrospective observational study done at a large referral tertiary care center in North India. All patients with synchronous or metachronous mCRC who received at least one dose of chemotherapy for metastatic disease, registered between 2003 to 2017 were included. Primary outcome measures were overall survival and progression-free survival and prognostic factors of overall survival. Descriptive analysis was done for the clinicopathological characteristics and treatment patterns. Kaplan Meier method for overall survival and progression-free survival. Cox regression analysis was performed for the determination of the prognostic factors for overall survival. Result Out of 377 eligible patients, 256 patients (68%) had de novo metastatic disease and the remaining 121 (32%) progressed to metastatic disease after initial treatment. The cohort was young (median age, 46 years) with the most common primary site being the rectum. A higher proportion of signet (9%) and mucinous histology (24%). The three common sites of metastasis were the liver, peritoneum, and lung. In the first line, most patients received oxaliplatin-based chemotherapy (70%). Only 12.5% of patients received biologicals in the first-line setting. The median follow-up and median overall survival of study cohort were 17 months and 18.5 months. The factors associated with poor outcome for overall survival on multivariate analysis were ECOG performance status of > 1, high CEA, low albumin, and the number of lines of chemotherapy received (< 2). Conclusion The outcome of mCRC is inferior to the published literature. We found a relatively higher proportion of patients with the following characteristics; younger, rectum as primary tumor location, the signet, and mucinous histology, higher incidence of peritoneum involvement. The routine use of targeted therapies is limited. Government schemes (inclusion of targeted therapies in the Ayushman scheme), NGO assistance, and availability of generic low-cost targeted drugs may increase the availability.

Trends in early onset colorectal cancer (EOCRC) in a South Asian cohort: data from a specialized tertiary care center in western Sri Lanka

“…The same study and several other authors have also reported a mean age of less than 50 years in Indian patients with CRC [11][12][13]. The CRC in the younger population is considered to be generally more aggressive and to have a higher chance of recurrence [14,15]. However, in this cohort, the EOCRC does not have a worse outcome.…”

A call for standardized reporting of early-onset colorectal peritoneal metastases

“…PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Sharma et al, 2021;Tabchouri et al, 2021;Yang et al, 2021;Zhou et al, 2021;Flood et al, 2022;Iwasaki et al, 2022;McCleary et al, 2022;Meyer et al, 2022;Nagao et al, 2022).…”

“…Forty-nine papers were excluded from the review for age-related reasons: six studies had 0–3 patients under age 50. Forty-three studies included patients under age 50 but did not present results stratified by age or did not stratify using an age ≤50 years old for stratification; one study provided above/below-age data but failed to include symbols (≥ or ≤) or descriptive text to indicate which group included the cutoff age (Sternberg et al , 1994; Nakae et al , 1995; Nakamura et al , 1999; Akasu et al , 2000; el-Ghazawy et al , 2001; Luna-Pérez et al , 2002; Al-Shamsi et al , 2003; Kanemitsu et al , 2003; Carmignani et al , 2004; Lloyd et al , 2006; Nervi et al , 2006; Lawson et al , 2008; Sobhani et al , 2008; Song et al , 2009; Aghili et al , 2010; Lemmens et al , 2011; Sjo et al , 2011; Lieu et al ., 2014; Park et al , 2014; Saluja et al , 2014; Adachi et al , 2015; Lam et al , 2015; Sica et al , 2015; Simkens et al , 2015; 2016; Maillet et al , 2016; Wang et al , 2016; Cicero et al , 2017; Hojo et al , 2017; Patil et al , 2017; Cigdem Arslan et al , 2018; Kondo et al , 2021; Melli et al , 2021; Rieser et al , 2021a, 2021b; Sharma et al , 2021; Tabchouri et al , 2021; Yang et al , 2021; Zhou et al , 2021; Flood et al , 2022; Iwasaki et al , 2022; McCleary et al , 2022; Meyer et al , 2022; Nagao et al , 2022).…”

Multimodality liver directed treatment for colorectal liver metastasis: Array of complementary options can improve outcomes - A single centre experience from India

“…With the availability of effective chemotherapy and access to a variety of ablative and non-surgical modalities of LDTs, an increasing number of patients with CRLM are being managed through a combination of the different treatment modalities ( 17 , 18 ). Though the multimodality approach has become an integral part of treating CRLM, literature exploring multimodality treatment outcomes is limited especially from the South Asian region ( 11 , 12 , 19 – 22 ). This is the largest series on multimodality liver-directed therapy in CRLM from the Indian sub-continent.…”

“…India has a low incidence of CRC compared to the West, but with the increasing availability of diagnostic modalities, an increasing number of cases are being detected ( 10 ). The available literature on CRLM from India and South Asia is extremely scarce, and available studies do not focus on the management of CRLM ( 11 , 12 ). This is one of the earliest experiences from South Asia highlighting the multidisciplinary management of CRLM and the oncologic outcomes.…”