Surgical Resection of Stage IV Colorectal Cancer and Prognosis

Abstract

Our results suggested that the most dismal CRC harbors three definite vectors that may represent the strongest phenotype of putative systemic immune (CA19-9), distant metastasis (extent of liver metastases), and local progression (peritoneal dissemination).

Analyses of Multiple Factors for Determination of "Selected Patients" Who Should Receive Rechallenge Treatment in Metastatic Colorectal Cancer: a Retrospective Study from Turkey

“…High levels of serum CEA on diagnosis has been associated with a poor prognosis in some studies, while others have found no significant correlation between CEA and prognosis (Stelzner et al, 2005;Katoh et al, 2008;Wen-Zhuo et al, 2014). The increase of CA 19-9 has demonstrated a significantly higher frequency of metastasis and distinctly lower survival rate, making it an adverse prognostic factor for CRC patients (Katoh et al, 2008;Levy et al, 2008).…”

“…The increase of CA 19-9 has demonstrated a significantly higher frequency of metastasis and distinctly lower survival rate, making it an adverse prognostic factor for CRC patients (Katoh et al, 2008;Levy et al, 2008). Katoh et al assessed the prognostic significance of elevated serum CA 19-9 levels.…”

“…The analysis of several studies have emphasized the importance of several clinical parameters such as age (Aslam et al, 2010), white blood cell, liver transaminases (Kemeny et al, 1983), haemoglobin (Graf et al, 1994), mean platelet volume (Tuncel et al, 2014), neutrophil/ lymphocyte ratio (Dirican et al, 2014;Wen-Zhuo et al, 2014), serum alkaline phosphatase (Chibaudel et al, 2003), serum γ-glutamyl transpeptidase (Wen-Zhuo et al, 2014), serum lactate dehydrogenase (Cetin et al, 2012), serum albumin (Tebbutt et al, 2003), tumor markers like CEA (Wen-Zhuo et al, 2014) and CA 19-9 (Katoh et al, 2008), ECOG PS (Galizia et al, 2008), primary tumor site (Bajwa et al, 2009), adjuvant chemotherapy (Katoh et al, 2008), pathological grade, number of metastatic sites (Yun et al, 2007), volume of liver metastases (Kleespies et al, 2009), metastasectomy (Settmacher et al, 2011) and state of KRAS/NRAS/BRAF mutation and PTEN loss (Tejpar et al, 2012;Yokota, 2012;Atreya et al, 2013) in the metastatic setting. Among these factors, patients with a V600E BRAF mutation have a poor prognosis which only settled in the guidelines (Bokemeyer et al, 2012).…”

Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

“…Increased survival might be explained by a difference in indication for blood transfusion or anatomic site studied, or because of the few confounding factors taken into account (preoperative hemoglobin, age, sex, Tokuhashi score [survival prognostication score], and number of instrumented levels) [7]. Previous studies in visceral metastatic disease have shown a negative effect of perioperative blood transfusion on survival [14,16]: Katoh et al [14] found that perioperative transfusion was independently associated with worse survival after resection of stage IV (disseminated disease) colorectal cancer (n = 162) after accounting for clinical and treatment parameters; Margulis et al [16] reported that survival of patients undergoing cytoreductive nephrectomy for metastatic renal cell carcinoma also was negatively influenced by intraoperative blood transfusion. The decrease in observed survival after perioperative blood transfusions in primary malignancies was not apparent in our study on metastatic long-bone fractures and might be explained by the already widely disseminated disease and poor overall survival, potentially attenuating the effect of blood transfusions.…”

Outcomes in the management of obstructive unresectable stage IV colorectal cancer

“…Both synchronic metastasis and bowel obstruction are considered poor prognosis factors as well as high preoperative levels of CA 19.9, histological grade, extension of liver metastasis or peritoneal metastases. 2,5,6 Resection of the primary tumour has been claimed to improve survival 7,8 but it has also been suggested that adding a surgical aggression to palliative patients with high volume disease may lead to high morbidity and mortality. The American Society of Clinical Oncology (ASCO) does not recommend resection of stage IV CRC in asymptomatic patients unless an intention to cure strategy is planned or when at risk of obstruction.…”