The predictive value of primary tumor location in patients with metastatic colorectal cancer: A systematic review

Boeckx, Nele; Janssens, Katleen; Camp, Guy Van; Rasschaert, Marika; Papadimitriou, Konstantinos; Peeters, Marc; Beeck, Ken Op de

doi:10.1016/j.critrevonc.2017.11.003

Cited by 46 publications

(49 citation statements)

References 101 publications

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“…Surprisingly, ECOG performance status (0–1 vs ≥ 2) and the number and location of metastases, factors that were expected to be of high prognostic significance, were nonsignificant in the multivariate analysis of patients on active treatment. Notably, while primary tumor location (PTL) has been shown to be prognostic in mCRC patients who received 1L therapy, there was no difference in OS between left‐side and right‐side tumors (7.0 vs 6.0 months, respectively, P = 0.13) in our study. Similarly, Arora et al .…”

Section: Discussioncontrasting

confidence: 66%

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Chiang

Choi

Lam

et al. 2019

Asia-Pac J Clncl Oncology

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Aim To investigate treatment patterns and outcomes of metastatic colorectal cancer (mCRC) patients beyond second progression (PD2) since regorafenib and TAS‐102 became available in Hong Kong. Methods The clinical records of consecutive mCRC patients who were treated beyond PD2 at Department of Clinical Oncology, Queen Mary Hospital between June 2013 and February 2018, were retrospectively reviewed. Results Of 176 PD2 patients (76.7% Eastern Cooperative Oncology Group performance status 0/1 and a median follow‐up time of 6.6 [range, 0.4–37.2] months), 104 (59%) underwent palliative care only and 72 (41%) received active third‐line (3L) treatment: regorafenib (n = 22), TAS‐102 (n = 6), chemotherapy + antiepidermal growth factor receptor (n = 12), chemotherapy + antivascular endothelial growth factor (n = 28) or clinical trials (n = 4). Patients on active 3L treatment had significantly longer OS than those on palliative care only: 11.7 versus 5.5 months (adjusted hazard ratio = 0.41, 95% confidence interval: 0.28–0.61, P < 0.001). For those on active treatment, OS was significantly associated with the time from diagnosis of metastasis to PD2 (P < 0.001) and post‐3L treatments (P = 0.009). When analyzing treatment eligibility according to trial criteria, half of the eligible patients (54/109) did not receive active treatment, but both eligible and ineligible patients achieved better OS when receiving active 3L treatment versus palliative care only (P < 0.001 and P = 0.002). No unexpected toxicity was reported. Conclusion Active 3L and beyond treatment significantly prolonged OS versus palliative care, even in selected “trial ineligible” patients. Given a high rate of palliation only care in eligible patients, improved patient access to medicine and counseling may be needed to maximize outcomes.

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Section: Discussioncontrasting

confidence: 66%

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Chiang

Choi

Lam

et al. 2019

Asia-Pac J Clncl Oncology

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“…At the molecular level, CRLMs from right‐sided primary tumours are more often KRAS / BRAF ‐mutated, enriched in microsatellite instability, CpG island methylation phenotype, and express BRAF ‐like and serrated pathway signature and consensus molecular subtype (CMS) 1. In contrast, left‐sided tumours harbour chromosomal instability and CMS2 more often. Therapeutically, CRLMs from right‐sided primary tumours tend to have a lower response rate to preoperative chemotherapy than left‐sided tumours.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases

Wang

Zhang

Wang

et al. 2019

British Journal of Surgery

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Background Primary tumour location is emerging as an important prognostic factor in localized and metastatic colorectal cancers. However, its prognostic role in colorectal liver metastasis (CRLM) after hepatectomy remains controversial. A systematic review and meta‐analysis was undertaken to evaluate its prognostic value. Methods References were identified through searches of PubMed, Embase, Web of Science and the Cochrane Library comparing overall or disease‐free survival after hepatic resection between patients with CRLM originating from right‐ or left‐sided colorectal cancers. Data were pooled using hazard ratios (HRs) and 95 per cent confidence intervals according to a random‐effects model. Meta‐regression and subgroup analyses were conducted to assess the effect of underlying confounding factors on HR estimates and to adjust for this. Results The final analysis included 21 953 patients from 45 study cohorts. Compared with left‐sided primary tumour location, right‐sided location was associated with worse overall survival (HR 1·39, 95 per cent c.i. 1·28 to 1·51; P < 0·001; prediction interval 1·00 to 1·93), and also tended to have a negative impact on disease‐free survival (HR 1·18, 1·06 to 1·32; P = 0·004; prediction interval 0·79 to 1·75). Subgroup analysis showed that the negative effect of right‐sided primary tumour location on overall survival was more prominent in the non‐Asian population (HR 1·47, 1·33 to 1·62) than the Asian population (HR 1·18, 1·05 to 1·32) (P for interaction <0·01). Conclusion This study demonstrated a prognostic role for primary tumour location in patients with CRLM receiving hepatectomy, especially regarding overall survival. Adding primary tumour location may provide important optimization of prognosis prediction models for CRLM in current use.

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“…This distinction has clinical significance as signet ring cell carcinoma is believed to be more aggressive with a poorer prognosis [7][8][9]. Furthermore, the primary tumor localization (i.e., right colon, left colon, or rectum) also has an impact on prognosis [10,11].…”

Section: Discussionmentioning

confidence: 99%

Rare Signet Ring Cell Adenocarcinoma of the Colon Metastasis to the Orbit

Bacorn

Lin

2020

Case Reports in Ophthalmological Medicine

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Metastases arising from primary tumors of the gastrointestinal tract are not commonly encountered in the orbit. Colorectal carcinomas are subcategorized based on morphological and genetic characteristics with these distinctions bearing therapeutic and prognostic significance. The behavior of these subcategories, including their propensity for orbital metastasis, differs, and clinicians treating these tumors must be aware of their metastatic profiles. This report describes a 51-year-old female with right upper lid swelling and ptosis ultimately found, what we believe to be, the first reported case of signet ring cell colon carcinoma metastasizing to the levator muscle and superior orbit. This case serves as a reminder to all clinicians to consider orbital metastasis even in malignancies not typically found in this location.

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The predictive value of primary tumor location in patients with metastatic colorectal cancer: A systematic review

Cited by 46 publications

References 101 publications

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Real‐world treatment patterns and outcomes in refractory metastatic colorectal cancer

Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases

Rare Signet Ring Cell Adenocarcinoma of the Colon Metastasis to the Orbit

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