Prognostic value of metastatic pattern in colorectal cancer: a multicenter retrospective analysis in a real-life cohort

Rumpold, Holger; Kirchweger, Patrick; Niedersüß-Beke, Dora; Falch, David; Wundsam, Helwig; Metz-Gercek, Sigrid; Piringer, Gudrun; Thaler, Josef

doi:10.1080/0284186x.2020.1837945

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…The largest study in pancreatic cancer consisted of a SEER (Surveillance, Epidemiology, and End Results) database analysis performed by Oweira et al 3 (n = 13,233), in which patients with lung metastases were noted to have significantly better overall survival and cancer-specific survival rates when compared with those with liver metastases (P < 0.0001), an observation corroborated in smaller retrospective series. 6 Similar favorable survival outcomes have been described for lung-only colorectal cancer metastases, including retrospective analyses reported by Prasanna et al 5 (n = 5967) and Rumpold et al 7 (n = 978). In contrast to pancreas and colorectal cancer, patients with isolated lung metastases from intrahepatic cholangiocarcinoma did not appear to have an improved prognosis compared with those with isolated metastatic involvement of other anatomic sites in a SEER analysis performed by Cheng et al 8 (n = 1567); however, numbers in each subgroup may not have been large enough to reach statistical significance.…”

Section: Discussionsupporting

confidence: 62%

Characteristics and Growth Rate of Lung Metastases in Patients With Primary Gastrointestinal Malignancies and Lung-dominant Metastatic Disease

Burns¹,

Vella²,

Paciorek

et al. 2021

American Journal of Clinical Oncology

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Introduction: There are no formal guidelines for the management of patients with primary gastrointestinal (GI) cancers who have lungexclusive or lung-predominant metastases. We performed a retrospective analysis to evaluate host and tumor characteristics of this patient population, model patterns and rates of growth, and describe treatment approaches.Materials and Methods: Eligible patients had a GI cancer with either synchronous or metachronous lung metastases but no other visceral or peritoneal sites of involvement. In addition to collecting detailed patient-specific and tumor-specific information, all imaging studies (computed tomography positron emission tomography scans) were reviewed by an independent radiologist. Up to 5 lung metastases were tracked through each patient's clinical course. Growth rate was estimated using a linear mixed model analysis.Results: Forty patients met eligibility criteria (18 pancreatic, 15 colorectal, 6 hepatobiliary, 1 gastroesophageal; synchronous vs. metachronous, 13 and 27, respectively). Median time from original cancer diagnosis to onset of metachronous lung lesions was 16 months. Interval from first appearance of lung metastases to treatment initiation was 6.2 months. Average growth rate of the largest lesion was 0.21 mm/ mo (95% confidence interval, 0.12-0.30), with substantial intrapatient and interpatient variability. Sixty percent of patients underwent locoregional interventions in addition to or in lieu of systemic therapy for their lung metastases. Median survival of the entire study cohort from first appearance of lung metastases was 54 months.Conclusions: Lung metastases from primary GI cancers have a variable but overall indolent natural history and are generally associated with prolonged survival outcomes. Further efforts to define patterns of growth of lung metastases, informed by size, number, and clinical/ molecular features, are needed to guide appropriate timing and selection of therapy as well as surveillance strategies.

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Section: Discussionsupporting

confidence: 62%

Characteristics and Growth Rate of Lung Metastases in Patients With Primary Gastrointestinal Malignancies and Lung-dominant Metastatic Disease

Burns¹,

Vella²,

Paciorek

et al. 2021

American Journal of Clinical Oncology

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“… [6] , explaining the poor outcome in PulMiCC with an mOS of only 42 months in the metastasectomy arm. This in contrast with 72–102 months for recently published population-based series [ 7 , 8 ]. The results for the non-randomised patients need to be fully published before the PulMiCC study can be put into perspective.…”

mentioning

confidence: 67%

Lung metastasectomy for colorectal cancer in the PulMiCC randomised controlled trial – Authors’ reply

Österlund

Isoniemi

2021

The Lancet Regional Health - Europe

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“…Several previous studies reported that the metastatic site is an important prognostic factor for synchronous metastatic colorectal cancer [6,7]. More important, the metastatic site seems to represent a malignancy with a different biological characteristics [7].…”

Section: Ivyspringmentioning

confidence: 99%

The survival impact of radiotherapy on synchronous metastatic rectal cancer: metastatic site can serve for radiotherapy-decision

Zhou¹,

Wang²,

Tan³

et al. 2022

J. Cancer

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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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Prognostic value of metastatic pattern in colorectal cancer: a multicenter retrospective analysis in a real-life cohort

Cited by 8 publications

References 19 publications

Characteristics and Growth Rate of Lung Metastases in Patients With Primary Gastrointestinal Malignancies and Lung-dominant Metastatic Disease

Characteristics and Growth Rate of Lung Metastases in Patients With Primary Gastrointestinal Malignancies and Lung-dominant Metastatic Disease

Lung metastasectomy for colorectal cancer in the PulMiCC randomised controlled trial – Authors’ reply

The survival impact of radiotherapy on synchronous metastatic rectal cancer: metastatic site can serve for radiotherapy-decision

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