Resectability and resection rates of colorectal liver metastases according to <i>RAS</i> and <i>BRAF</i> mutational status: prospective study

Uutela, Aki; Nordin, Arno; Osterlund, Emerik; Halonen, Päivi; Kallio, Raija; Soveri, Leena‐Maija; Salminen, Tapio; Ålgars, Annika; Ristimäki, Ari; Ovissi, Ali; Lamminmäki, Annamarja; Muhonen, Timo; Kononen, Juha; Ristamäki, Raija; Heervä, Eetu; Stedt, Hanna; Lehtomäki, Kaisa; Kytölä, Soili; Sundström, Jari; Mäkinen, Markus J.; Nieminen, Lasse; Kuopio, Teijo; Keinänen, Mauri; Österlund, Pia; Isoniemi, Helena; Mäkisalo, Heikki; Huuhtanen, Riikka; Lantto, Eila; Kosunen, Juhani; Leppä, Sirpa; Bono, Petri; Mattson, Johanna; Räsänen, Jari; Lepistö, Anna; Penttinen, Heidi; Mäkelä, Siru; Carpén, Olli; Lundbom, Nina; Hakkarainen, Antti; Timonen, Marjut; Salminen, Veera; Paunu, Niina; Rinta-Kiikka, Irina; Vornanen, Martine; Virtanen, Johanna; Korkeila, Eija; Sutinen, Eija; Lavonius, Maija; Blanco, Roberto; Pääkkö, Eija; Tuomisto-Huttunen, Tiina; Auvinen, Päivi; Kärjä, Vesa; Kainulainen, Sakari; Kettunen, Hannu-Pekka; Kellokumpu, Ilmo; Aarnio, Markku; Väyrynen, Ville; Vasala, Kaija; Ketola, Sanna; Nuorva, Kyösti; Murashev, Maija-Leena; Pulkkanen, Kalevi; Viitanen, Venla; Nieppola, Marko; Haalisto, Elina; Nyandoto, Paul; Aalto, Aino; Ala-Luhtala, Timo; Tuominiemi, Jukka; Sainast, Anneli; Pusa, Laura; Helle, Leena; Hermansson, Terhi; Kokko, R.; Aroviita, Laura; Nokisalmi, Petri; Sailas, Liisa; Tokola, Heikki; Jekunen, Antti; Pöytäkangas, Teemu; Möykkynen, Kari; Kosonen, Sanna; Isokangas, Olli-Pekka; Vaarala, Svea; Klaavuniemi, Tuula; Kolle, Rainer; Karihtala, Peeter; Heikkinen, Mirja; Johansson, Kaisu; Sjöstrand, Anna; Kajasviita, Piia; Kaleva‐Kerola, Jaana; Männistö, Esa; Lindvall-Andersson, R.; Kaunismaa, Tom; Vihinen, Pia; Cavalli-Björkman, Nina

doi:10.1093/bjs/znac424

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…Another patient-related factor that is correlated with patient survival is the mutation of the RAS family gene, with the incidence of such mutations reaching as high as 42.3% in the reported literature [56]. Several studies have identified a decreased overall survival in patients with RAS mutations after systemic chemotherapy, resection, and thermal ablation [9,56,57]. The risk for earlier LTP is fifteen times higher than the wild-type RAS when treated with insufficient margins [31].…”

Section: Discussionmentioning

confidence: 99%

The Importance of Optimal Thermal Ablation Margins in Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of 21 Studies

Chlorogiannis,

Sotirchos,

Georgiades

et al. 2023

Cancers

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Background: Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the US. Thermal ablation (TA) can be a comparable alternative to partial hepatectomy for selected cases when eradication of all visible tumor with an ablative margin of greater than 5 mm is achieved. This systematic review and meta-analysis aimed to encapsulate the current clinical evidence concerning the optimal TA margin for local cure in patients with colorectal liver metastases (CLM). Methods: MEDLINE, EMBASE, and the CENTRAL databases were systematically searched from inception until 1 May 2023, in accordance with the PRISMA Guidelines. Measure of effect included the risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Results: Overall, 21 studies were included, comprising 2005 participants and 2873 ablated CLMs. TA with margins less than 5 mm were associated with a 3.6 times higher risk for LTP (n = 21 studies, RR: 3.60; 95% CI: 2.58–5.03; p-value < 0.001). When margins less than 5 mm were additionally confirmed by using 3D software, a 5.1 times higher risk for LTP (n = 4 studies, RR: 5.10; 95% CI: 1.45–17.90; p-value < 0.001) was recorded. Moreover, a thermal ablation margin of less than 10 mm but over 5 mm remained significantly associated with 3.64 times higher risk for LTP vs. minimal margin larger than 10 mm (n = 7 studies, RR: 3.64; 95% CI: 1.31–10.10; p-value < 0.001). Conclusions: This meta-analysis solidifies that a minimal ablation margin over 5 mm is the minimum critical endpoint required, whereas a minimal margin of at least 10 mm yields optimal local tumor control after TA of CLMs.

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Section: Discussionmentioning

confidence: 99%

The Importance of Optimal Thermal Ablation Margins in Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of 21 Studies

Chlorogiannis,

Sotirchos,

Georgiades

et al. 2023

Cancers

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“…Right colon PTL was, as discussed above, associated with a higher incidence of BRAF mt and dMMR, and also high RAS mt rates, which were associated with lower metastasectomy rates [ 7 , 43 , 44 ]. This is not unexpected, since BRAF mt patients often have metastases in organs considered unresectable, such as the peritoneum and distant lymph nodes, while RAS mt patients have metastases in lungs and brain.…”

Section: Discussionmentioning

confidence: 99%

Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)

Aho,

Osterlund,

Ristimäki

et al. 2024

Cancers

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The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan–Meier, and Cox regression were used to compare the groups. The PTL was in the right colon in 310 patients (29%), the left colon in 396 patients (37%), and the rectum in 375 patients (35%). The PTL was associated with distinct differences in metastatic sites during the disease trajectory. The resectability, conversion, and resection rates were lowest in the right colon, followed by the rectum, and were highest in the left colon. Overall survival was shortest for right colon compared with left colon or rectal PTL (median 21 vs. 35 vs. 36 months), with the same trends after metastasectomy or systemic therapy only. PTL also remained statistically significant in a multivariable model. The distribution of symptoms varied according to PTL, especially between the right colon (with general symptoms of metastases) and rectal PTL (with sexual- and bowel-related symptoms). mCRC, according to PTL, behaves differently regarding metastatic sites, resectability of the metastases, outcomes of treatment, and HRQoL.

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Resectability and resection rates of colorectal liver metastases according to RAS and BRAF mutational status: prospective study

Cited by 2 publications

References 20 publications

The Importance of Optimal Thermal Ablation Margins in Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of 21 Studies

The Importance of Optimal Thermal Ablation Margins in Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of 21 Studies

Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)

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