Survival outcomes following primary tumor resection for patients with incurable metastatic colorectal carcinoma: Experience from a single institution

Lau, Joel; Chang, Heidi; Lee, Kai Y; Gwee, Yong Xiang; Lee, Wen Q; Chong, Choon Seng

doi:10.1111/1751-2980.12657

Cited by 9 publications

(6 citation statements)

References 39 publications

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“…The potential advantages of PTR as described as follows: 1) Prevention of imminent tumor-related complications such as bowel obstruction, tumor bleeding, and bowel perforation; 2) removal of radiotherapy (RT)-or chemotherapy-resistant tumor cells; and 3) reduction of the tumor burden. [13,14] Conversely, the potential major disadvantages of PTR lie in the interruption of systemic therapy. During PTR, chemotherapy is usually delayed for approximately 2 weeks before and after the surgery to avoid immune compromise, [15,16] and the administration of antivascular endothelial growth factor monoclonal antibodies, such as bevacizumab, is often postponed for at least 28 days before and after colorectal surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[21][22][23] However, many of these analyses have included studies where PTR was followed by either intensive or palliative chemotherapy. [13,14,24] Moreover, systemic therapy typically involves chemotherapy without targeted therapy. [13,14,24] Notably, survival outcome data for mCRC with synchronous unresectable distant metastasis following neoadjuvant chemotherapy and targeted therapy are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…[13,14,24] Moreover, systemic therapy typically involves chemotherapy without targeted therapy. [13,14,24] Notably, survival outcome data for mCRC with synchronous unresectable distant metastasis following neoadjuvant chemotherapy and targeted therapy are lacking. In the present single-institution study, we retrospectively evaluated 74 patients with mCRC with synchronous unresectable distant metastasis who received bevacizumab plus FOLFIRI (folinic acid, 5-uorouracil, and irinotecan).…”

Section: Introductionmentioning

confidence: 99%

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Survival Benefits of Asymptomatic Primary Tumor Resection After Bevacizumab Plus FOLFIRI as First-Line Therapy for Patients with Metastatic Colorectal Cancer with Synchronous Unresectable Metastasis

Chen,

Chang,

et al. 2024

Preprint

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Background Metastatic colorectal cancer (mCRC) poses a clinical challenge and requires a combination of systemic therapy and conversion surgery. Although first-line chemotherapy and targeted therapy are considered the standard treatments for mCRC, the role of primary tumor resection (PTR) in asymptomatic synchronous mCRC with unresectable metastatic lesion after initial therapy remains relatively underexplored. Materials A retrospective review was conducted from January 2015 to January 2021, involving 74 patients with synchronous mCRC who received bevacizumab plus FOFIRI as first-line systemic therapy. All 74 patients had unresectable metastatic lesions confirmed through multidisciplinary team discussion. Patient characteristics, PTR data, and radiotherapy (RT) and overall survival (OS) outcomes were analyzed. The patients were categorized into a “PTR” group and a “No PTR” group and then further stratified into “4A,” “4B,” and “4C” subgroups based on the initial mCRC stage. Additionally, four subgroups—namely “PTR(+)/RT(+),” “PTR(+)/RT(−),” “PTR(−)/RT(+),” and “PTR(−)/RT(−)”—were formed to assess the combined effects of PTR and RT. Results The median OS for all the patients was 23.8 months (20.5–27.1 months). The “PTR” group exhibited a significantly higher median OS of 25.9 months (21.3–30.5 months) compared with 21.4 months (15.8–27.1 months) in the “No PTR” group (p = 0.048). Subgroup analyses revealed a trend of improved survival with PTR in patients with stage IVA and IVB; however, the results were not statistically significant (p = 0.116 and 0.493, respectively). A subgroup analysis of PTR and RT combinations revealed no significant difference in median OS rates. Conclusion For asymptomatic mCRC with synchronous unresectable distant metastasis, PTR following first-line therapy with bevacizumab plus FOLFIRI can provide a survival benefit, particularly in stage IVA/IVB patients compared with stage IVC patients. Additionally, RT for primary tumor did not provide an additional OS benefit in mCRC with unresectable metastasis. A prospective randomized trial with a larger sample size is essential to further elucidate the role of PTR in this context.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival Benefits of Asymptomatic Primary Tumor Resection After Bevacizumab Plus FOLFIRI as First-Line Therapy for Patients with Metastatic Colorectal Cancer with Synchronous Unresectable Metastasis

Chen,

Chang,

et al. 2024

Preprint

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“…Approximately 10%-25% of patients with CRC develop peritoneal metastasis (PM) after initial diagnosis[ 4 ]. Compared with other CRC metastatic sites, PM is associated with poorer progression-free survival and overall survival[ 5 , 6 ]. As a result, in the 8 th edition of the tumor, node, metastasis staging system published by the American Joint Committee on Cancer, PM was classified as M1c since it has a worse prognosis when compared with patients with one distant organ metastasis (M1a) and those with more than one distant organ metastasis (M1b)[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram for predicting metachronous peritoneal metastasis in colorectal cancer: A retrospective study

Ban¹,

Shang²,

Shi³

2023

World J Gastrointest Oncol

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“…In regard to synchronous metastatic CRC, the peritoneum is the second most common metastatic site, secondary to the liver (7). Peritoneal metastasis (PM) is associated with poorer progression-free survival and OS, as compared to other CRC metastatic sites (8)(9)(10). In the 8th edition of the American Joint Committee on Cancer (AJCC) TNM Classification for CRC, patients with PM are separately classified into an M1c group since they were found to have the worst prognosis compared to patients in the M1a (metastases to one organ) and M1b (metastases to more than one organ) groups (11,12).…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Prognostic Nomogram for Colorectal Cancer Patients With Synchronous Peritoneal Metastasis

et al. 2021

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PurposeSynchronous peritoneal metastasis (S-PM) is considered a poor prognostic factor for colorectal cancer (CRC) and there is no nomogram to predict the survival of these patients. In this study, we aimed to use a multicenter data to identify the factors associated with S-PM of CRC to construct a nomogram for predicting the overall survival (OS) of these patients.MethodsCRC patients with S-PM from two medical centers were enrolled between September 2007 and June 2017. Multivariate analysis was used to identify independent factors associated with OS for the nomogram to predict the 1-, 2-, and 3-year OS rates in the development group. The concordance index (C-index), calibration plot, relative operating characteristic (ROC) curve with area under the curve (AUC) were calculated to evaluate the performance of the nomogram in both the development and an external validation group.Results277 CRC patients with S-PM in the development group and 68 patients in the validation group were eligible for this study. In multivariate analysis of development group, age, carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and chemotherapy were independent variables for OS, based on which the nomogram was built. The C-index of the nomogram in the development and validation group was 0.701 (95% Cl, 0.666–0.736) and 0.716 (95% Cl, 0.622–0.810); demonstrating good discriminative ability. The calibration plots showed satisfactory consistency between actual observation and nomogram-predicted OS probabilities in the development and external validation group. The nomogram showed good predictive accuracy for 1-, 2-, and 3-year OS rates in both groups with AUC >0.70. An online dynamic webserver was also developed for increasing the ease of the nomogram.ConclusionsWe developed and validated a predictive nomogram with good discriminative and high accuracy to predict the OS in CRC patients with S-PM.

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Survival outcomes following primary tumor resection for patients with incurable metastatic colorectal carcinoma: Experience from a single institution

Abstract: The absences of PTR and PC, and peritoneal metastases are independently associated with decreased OS in patients with unresectable metastatic CRC. Randomized controlled trials are needed to verify this observation.

Cited by 9 publications

References 39 publications

Survival Benefits of Asymptomatic Primary Tumor Resection After Bevacizumab Plus FOLFIRI as First-Line Therapy for Patients with Metastatic Colorectal Cancer with Synchronous Unresectable Metastasis

Survival Benefits of Asymptomatic Primary Tumor Resection After Bevacizumab Plus FOLFIRI as First-Line Therapy for Patients with Metastatic Colorectal Cancer with Synchronous Unresectable Metastasis

Development and validation of a nomogram for predicting metachronous peritoneal metastasis in colorectal cancer: A retrospective study

Development and Validation of a Prognostic Nomogram for Colorectal Cancer Patients With Synchronous Peritoneal Metastasis

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