Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

Radulova-Mauersberger, Olga; Zschuppe, Ernst; Kittner, Thomas; Abolmaali, Nasreddin; Puffer, E; Zimmer, Joerg; Witzigmann, Helmut

doi:10.1002/jso.25578

Cited by 22 publications

(17 citation statements)

References 41 publications

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“…A significant difference in the median overall survival was observed at 10–11 months in those who underwent cancer‐directed surgery compared with 2–3 months in those who did not 19,20 . Furthermore, several studies performed in Europe have also shown a clear benefit in the survival of patients who undergo resection of both primary tumor and metastatic disease compared to those who did not 21‐23 . Siebenhuner et al (2020) performed a recent SEER review evaluating adult patients with diagnosis of metastatic colorectal cancer from 2010–2015 who underwent resection of primary tumor and metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection and survival outcomes in metastatic young adult colorectal cancer patients

et al. 2021

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Background The incidence of colorectal cancer in adults younger than age 50 has increased with rates expected to continue to increase over the next decade. The objective of this study is to examine the survival benefit of surgical resection (primary and/or metastatic) versus palliative therapy in this patient population. Methods We identified 6708 young adults aged 18–45 years diagnosed with metastatic colorectal cancer (mCRC) from 2004 to 2015 from the SEER database. Overall survival (OS) was analyzed using Kaplan–Meier estimation, log rank test, and multivariate Cox proportional hazards model. Results Sixty‐three percent of patients in our study underwent primary tumor resection (PTR), with 40% undergoing PTR alone and 23% undergoing both resection of primary disease and metastasectomy. The median OS for patients who underwent both PTR and metastasectomy was 36 months, compared to 13 months for those who did not receive any surgical intervention. The multivariate analysis showed significant OS benefit of receiving both PTR and metastasectomy (HR 0.34, 95% CI: 0.31–0.37, p < 0.001) compared to palliative therapy. Undergoing PTR only and metastasectomy only were also associated with improved OS (HR 0.46, 95% CI: 0.43–0.49, p < 0.001 and HR 0.64, 95% CI: 0.55–0.76, p < 0.001, respectively). Conclusion This is the largest observational study to evaluate survival outcomes in young‐onset mCRC patients and the role of surgical intervention of the primary and/or metastatic site. Our study provides evidence of statistically significant increase in OS for young mCRC patients who undergo surgical intervention of the primary and/or metastatic site.

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Section: Discussionmentioning

confidence: 99%

Surgical resection and survival outcomes in metastatic young adult colorectal cancer patients

et al. 2021

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“…The median survival time of patients with unresectable intrahepatic metastases is less than 12 mo[ 20 ]. For patients with resectable CLM, the 5-year survival rate of those who choose radical resection is between 38% and 58%[ 21 , 22 ], and the benefits are obvious. We found that the following three factors determined the possibility of radical resection: The distribution of CLMs, the diameter of the largest CLM, and the distance to great vessels.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors and therapeutic effects of different treatment modalities for colorectal cancer liver metastases

Wang

Wei

et al. 2020

WJGO

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BACKGROUND Colorectal cancer (CRC) is one of the most common malignant tumors in China, and the liver is the most common metastatic site in patients with advanced CRC. Hepatectomy is the gold standard treatment for colorectal liver metastases. For patients who cannot undergo radical resection of liver metastases for various reasons, ablation therapy, interventional therapy, and systemic chemotherapy can be used to improve their quality of life and prolong their survival time. AIM To explore the prognostic factors and treatments of liver metastases of CRC. METHODS A retrospective analysis was conducted on 87 patients with liver metastases from CRC treated at the Liaoning Cancer Hospital and Institute between January 2005 and March 2011. According to different treatments, the patients were divided into the following four groups: Surgical resection group (36 patients); ablation group (23 patients); intervention group (15 patients); and drug group (13 patients). The clinicopathological data and postoperative survival of the four groups were analyzed. The Kaplan-Meier method was used for survival analysis, and the Cox proportional hazards regression model was used for multivariate analysis. RESULTS The median survival time of the 87 patients was 38.747 ± 3.062 mo, and the 1- and 3-year survival rates were 87.5% and 53.1%, respectively. The Cox proportional hazards model showed that the following factors were independent factors affecting prognosis: The degree of tumor differentiation, the number of metastases, the size of metastases, and whether the metastases are close to great vessels. The results of treatment factor analysis showed that the effect of surgical treatment was better than that of drugs, intervention, or ablation alone, and the median survival time was 48.83 ± 4.36 mo. The drug group had the worst prognosis, with a median survival time of only 13.5 ± 0.7 mo ( P < 0.05). For patients with liver metastases of CRC near the great vessels, the median survival time (27.3 mo) of patients undergoing surgical resection was better than that of patients using other treatments (20.6 mo) ( P < 0.05). CONCLUSION Patients with a low degree of primary tumor differentiation, multiple liver metastases (number of tumors > 4), and maximum diameter of liver metastases > 5 cm have a poor prognosis. Among drug therapy, intervention, ablation, and surgical treatment options, surgical treatment is the first choice for liver metastases. When liver metastases are close to great vessels, surgical treatment is significantly better than drug therapy, intervention, and ablation alone.

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“…Shimizu et al (80) recently analyzed the outcomes of PM in patients with a history of liver metastases and showed that a high preoperative CEA level was an independent prognostic factor for the overall survival. Although there have been only a few reports on PM for patients with both pulmonary and hepatic metastases detected simultaneously with the primary tumor, PM for such patients was still shown to provide favorable long-term outcomes (81,82). However, a history of distant metastases other than to the liver is believed to be a poor prognostic factor (72,79).…”

Section: Prognostic Factors For Each Tumor Type Crcmentioning

confidence: 99%

Preoperative evaluation and indications for pulmonary metastasectomy

Kanzaki¹,

Fukui²,

Kanou³

et al. 2021

J Thorac Dis

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Pulmonary metastasectomy (PM) is an established treatment that can provide improved longterm survival for patients with metastatic tumor(s) in the lung. In the current era, where treatment options other than PM such as stereotactic body radiation therapy (SBRT), immunotherapy, and molecular-targeted therapy are available, thoracic surgeons should review the approach to the preoperative evaluation and the indications. Preoperative evaluation consists of history and physical examinations, physiological tests, and radiological examinations. Radiological examinations serve to identify the differential diagnosis of the pulmonary nodules, evaluate their precise number, location, and features, and search for extra thoracic metastases. The indication of PM should be considered from both physiological and oncological points of view. The general criteria for PM are as follows; (I) the patient has a good general condition, (II) the primary malignancy is controlled, (III) there is no other extrapulmonary metastases, and (IV) the pulmonary lesion(s) are thought to be completely resectable. In addition to the general eligibility criteria of PM, prognostic factors of each tumor type should be considered when deciding the indication for PM. When patients have multiple poor prognostic factors and/or a short disease-free interval (DFI), thoracic surgeons should not hesitate to observe the patient for a certain period before deciding on the indication for PM. A multidisciplinary discussion is needed in order to decide the indication for PM.

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Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

Cited by 22 publications

References 41 publications

Surgical resection and survival outcomes in metastatic young adult colorectal cancer patients

Surgical resection and survival outcomes in metastatic young adult colorectal cancer patients

Prognostic factors and therapeutic effects of different treatment modalities for colorectal cancer liver metastases

Preoperative evaluation and indications for pulmonary metastasectomy

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