Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice

Fanotto, Valentina; Salani, Francesca; Vivaldi, Caterina; Scartozzi, Mario; Ribero, Dario; Puzzoni, Marco; Montagnani, Francesca; Leone, Francesco; Vasile, Enrico; Bencivenga, Maria; Manzoni, Giovanni De; Basile, Debora; Fornaro, Lorenzo; Masi, Gianluca; Aprile, Giuseppe

doi:10.3390/cancers15030900

Cited by 6 publications

(7 citation statements)

References 140 publications

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“…Our results showed that the CEUS mode and quantitative parameters differed among the different hepatic metastasis groups in PDAC ( Figure 5 ), where the WIS ratio may be an important factor in assessing the risk of hepatic metastasis. The presence of hepatic metastases is an important independent prognostic factor for PDAC ( 18 ). Unfortunately, in current medical developments, it can only be accurately assessed at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

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Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Jia¹,

Yang²,

Chen³

et al. 2023

Quant Imaging Med Surg

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Background: Contrast-enhanced ultrasound (CEUS) has proven valuable in diagnosing benign and malignant pancreatic diseases, but its value in evaluating hepatic metastasis remains to be further explored.This study investigated the relationship between CEUS features of pancreatic ductal adenocarcinoma (PDAC) and concomitant or recurrent liver metastases after treatment.Methods: This retrospective study included 133 participants with PDAC who were diagnosed with pancreatic lesions with CEUS at Peking Union Medical College Hospital from January 2017 to November 2020. According to the CEUS classification methods in our center, all the pancreatic lesions were classified as either with rich or poor blood supply. Additionally, quantitative ultrasonographic parameters were measured in the center and periphery of all pancreatic lesions. CEUS modes and parameters of the different hepatic metastasis groups were compared. The diagnostic performance of CEUS was calculated for diagnosing synchronous and metachronous hepatic metastasis.Results: The proportions of rich blood supply and poor blood supply were 46% (32/69) and 54% (37/69), respectively, in the no hepatic metastasis group; 42% (14/33) and 58% (19/33), respectively, in the metachronous hepatic metastasis (MHM) group; and 19% (6/31) and 81% (25/31), respectively, in the synchronous hepatic metastasis (SHM) group. The wash-in slope ratio (WIS ratio) between the center of the lesion and around the lesion and peak intensity ratio (PI ratio) between the center of the lesion and around the lesion had higher values in the negative hepatic metastasis group (P<0.05). In predicting synchronous and metachronous hepatic metastasis, the WIS ratio had the best diagnostic performance. The sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) were 81.8%, 95.7%, 91.2%, 90.0%, and 91.7%, respectively, for MHM; and 87.1%, 95.7%, 93.0%, 90.0%, and 94.3%, respectively, for SHM. MethodsThis study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The institutional review board of Peking Union Medical College Hospital approved the study (No. SK1733), and the requirement for individual consent for this retrospective analysis was waived.Conclusions: CEUS would be helpful in image surveillance for synchronous or metachronous hepatic metastasis of PDAC.

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Section: Discussionmentioning

confidence: 99%

“…], serum tumor marker detection, US, and contrastenhanced computed tomography (CECT). When CECT was still unable to determine the nature of the liver mass, dynamic MRI 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) imaging was chosen.…”

Section: Patientsmentioning

confidence: 99%

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Jia¹,

Yang²,

Chen³

et al. 2023

Quant Imaging Med Surg

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“…Our analysis fits into the broad and controversial scenario of the management of primary tumor in synchronous metastatic CRC patients. While in the case of symptomatic primary tumors, the indication for surgery is a need rather than a choice, in the case of asymptomatic primary tumors, literature data are conflicting about the benefit of PTR in terms of survival [12,[15][16][17][18][19][20], as demonstrated by two recent meta-analyses mainly including nonrandomized, single-center, retrospective studies that came to opposite conclusions [19,20]. Notably, an intrinsic high risk of selection bias affected these analyses, together with the lack of data about QoL, administered treatments, reason for resection/no resection, baseline disease status, biological profile, and prognostic factor related to each individual patient.…”

Section: Discussionmentioning

confidence: 99%

“…Major guidelines currently recommend PTR in metastatic CRC patients only in the presence of overt symptoms or in the case of high risk of their imminent onset, while systemic treatment is recommended as the preferred initial step for asymptomatic patients [1,10,11], though it must be acknowledged that the management of the primary tumor is still an open issue [12]. Here, we present the results of a pooled analysis of two prospective, open-label, multicentric phase III randomized trials, TRIBE (NCT00719797) and TRIBE2 (NCT02339116), where untreated metastatic CRC patients received upfront chemotherapy (FOLFOXIRI, FOLFOX, or FOLFIRI) plus bevacizumab (bev).…”

Section: Introductionmentioning

confidence: 99%

Primary Tumor Resection in Synchronous Metastatic Colorectal Cancer Patients Treated with Upfront Chemotherapy plus Bevacizumab: A Pooled Analysis of TRIBE and TRIBE2 Studies

Fanotto,

Rossini,

Casagrande

et al. 2023

Cancers

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Background: The decision to resect or not the primary tumor in asymptomatic patients with synchronous metastatic colorectal cancer (mCRC) is a complex and challenging issue for oncologists, especially when an antiangiogenic-based therapy is planned. Methods: Patients enrolled in the phase III TRIBE and TRIBE2 studies that compared upfront FOLFOXIRI + bevacizumab to FOLFIRI or FOLFOX + bevacizumab, respectively, were included. We assessed the association of primary tumor resection (PTR) with progression-free survival (PFS), overall survival (OS), response rate (ORR), rate of grade > 2 adverse events (AEs), and serious gastrointestinal and surgical AEs in the overall population and according to the treatment arm. Results: Of the 999 patients included, 513 (51%) underwent PTR at baseline. Longer PFS and OS were observed in resected patients compared to those with unresected primary tumors: 11.2 vs. 10.0 months (p < 0.001) and 26.6 vs. 22.5 (p < 0.001), respectively. In multivariate models, PTR was confirmed as an independent prognostic factor for better PFS (p = 0.032) and OS (p = 0.018). Patients with PTR experienced a higher incidence of grade 3 or 4 diarrhea (p = 0.055) and lower incidence of anemia (p = 0.053), perforation (p = 0.015), and serious gastrointestinal and surgical AEs (p < 0.001). No statistically significant differences were noted in incidence of bleeding (p = 0.39). The benefit of FOLFOXIRI + bevacizumab in terms of PFS (p for interaction: 0.46), OS (p for interaction: 0.80), ORR (p for interaction: 0.36), and incidence of grade 3 or 4 AEs was independent of PTR. Conclusions: PTR at baseline was independently associated with good prognosis in synchronous mCRC patients and with lower incidence of serious gastrointestinal and surgical AEs during upfront chemotherapy plus bevacizumab. The benefit and toxicity profile of FOLFOXIRI plus bevacizumab was independent of PTR.

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“…The principal therapeutic strategy for mCRC (Metastatic colorectal cancer) patients is palliative chemotherapy, at the same time, non-systematic therapy (such as surgery and optional radiation and ablative techniques) is optional for patients with respectable metastatic lesions to improve survival [2]. The early-stage primary disease typically requires laparoscopic surgery; cases involving metastases necessitate open surgery for tumor resection, and nonresectable cases typically require adjuvant radiotherapy [3]. Neoadjuvant and palliative chemotherapies [4], immunotherapy [5], and tyrosine kinase inhibitor (TKI) [6] therapy are additional CRC treatments.…”

Section: Introductionmentioning

confidence: 99%

PLA-HA/Fe3O4 magnetic nanoparticles loaded with curcumin: physicochemical characterization and toxicity evaluation in HCT116 colorectal cancer cells

Bourang,

Asadian,

Noruzpour

et al. 2024

Discov Appl Sci

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Colorectal cancer (CRC) is the third most common, harmful, and universal cancer and the second lethal type. This paper discusses the therapeutic potential of curcumin, a significant curcuminoid found in the substructure of plant Curcuma longa (turmeric), against CRC. Curcumin has the ability to disrupt a variety of cellular signaling pathways and has been validated in several preclinical and clinical studies, but suffers from low solubility and bioavailability. Despite the widespread use of curcumin (CU) against colorectal cancer, it presents limitations, such as low solubility and bioavailability. Due to these drawbacks, researchers focused on new methods to carry CU into cells to overcome the limits of treatments with CU. One of the leading solutions is bioanalytical methods, which are based on using CU in combination with nanoparticles, especially magnetic nanoparticles, which cause the targeted transfer of the drug to cancer cells. To address these issues, PLA-HA/Fe3O4 magnetic nanoparticles were synthesized and loaded with curcumin. The average size and zeta potential of the nanoparticles and the magnetic properties were measured. The drug encapsulation efficiency and cumulative release of curcumin from the nanoparticles under acidic and neutral pH (4.8, 6, and 7.4) values were evaluated, as well as the cytotoxic effect of the nanoparticles on HCT116 colorectal cancer cells. According to the results of DLS and TEM analysis, PLA/Fe3O4/curcumin nanoparticles had a spherical structure with an average size of 208 Å ± 12.8 nm and a Zeta potential of − 18 (mV). The drug encapsulation efficiency in PLA-HA/Fe3O4 nanoparticles was 24.8 ± 4.6 percent. The drug's release rate was influenced by acidic and neutral pH levels. After 14 days, the highest release rate was 98% at pH 4.8 and over 94% at pH 6 (typical of cancer cells). In contrast, the drug's release at pH 7.4 (typical of healthy cells) after 14 days was only 59%. The results demonstrated that nanoparticles have a high degree of biocompatibility and the ability to carry Curcumin medications. HCT116 cells with 200 μg/ml PLA-HA/Fe3O4/Curcumin nanoparticles have 58.63 ± 3.7% percent cell viability. Ultimately, PLA-HA, Fe3O4, and Curcumin's physicochemical characteristics and impact on cell viability render them valuable instruments for precisely delivering drugs to colorectal cancer cells. The PLA-HA/Fe3O4–curcumin nanoparticles demonstrated a well-targeted drug delivery system for upcoming colorectal cancer treatments, as evidenced by their strong cytotoxic effects on colorectal cancer cells and negligible toxicity towards non-cancerous cells. Graphical abstract

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Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice

Cited by 6 publications

References 140 publications

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Primary Tumor Resection in Synchronous Metastatic Colorectal Cancer Patients Treated with Upfront Chemotherapy plus Bevacizumab: A Pooled Analysis of TRIBE and TRIBE2 Studies

PLA-HA/Fe3O4 magnetic nanoparticles loaded with curcumin: physicochemical characterization and toxicity evaluation in HCT116 colorectal cancer cells

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