Trends in epidemiology, treatment and molecular testing of metastatic colorectal cancer in a real‐world multi‐institution cohort study

Abstract

Aim Colorectal cancer (CRC) is the third most common cancer in Australia, and survival after diagnosis of metastatic disease is improving. Our aim was to assess trends in epidemiology, treatment, molecular testing and survival in patients with metastatic CRC (mCRC). Methods Clinical data from February 2013 to December 2018 was recorded in a prospective, observational, multicenter cohort study conducted in Queensland, Australia, examining clinical and molecular biomarkers in cases of mCRC. Results A total of 159 patients who had metastasis diagnosed after February 2013 were included in survival analysis. Median age at diagnosis was 63.9 years, but 29% had early‐onset disease (diagnosis aged <50 years). Median overall survival was 2.5 years (95% confidence interval [CI], 2.2–3.0) for the 159 patients included in survival analysis. Independent factors correlated with poor prognosis included right‐sided primary tumor, neutrophil–lymphocyte ratio >5, increased alkaline phosphatase level (ALP) and an increasing number of sites of metastatic disease. In contrast, metastasectomy was associated with improved overall survival (adjusted HR = 0.29’ 95% CI, 0.16–0.54), with similar survival between patients who had liver and non‐liver metastasectomy sites. Half (10/20) of the BRAF mutant CRC were also microsatellite unstable. The proportion of detected mutations amongst tested samples increased over time for Kirsten Rat Sarcoma (KRAS; OR [per year] = 1.19; 95% CI, 1.01–1.39). Concurrently, the methods of molecular genetics testing employed in routine clinical practice changed towards the adoption of next‐generation sequencing. Conclusions Metastasectomy in mCRC may be beneficial regardless of the anatomical site of metastasis. The adoption of next‐generation sequencing techniques for molecular genetics testing coincided with a slightly increased rate of detection of KRAS and BRAF mutations, potentially reflecting greater test sensitivity. Further translational research is required in mCRC to define novel targets for treatment.

Outcomes of Combined Peritoneal and Local Treatment for Patients with Peritoneal and Limited Liver Metastases of Colorectal Origin: A Systematic Review and Meta-Analysis

“… 1 Metastases are present at diagnosis in 20 to 25% of cases, and for another 20 to 25% of patients, metastatic disease develops after initial surgical treatment. 2 , 3 For the majority of these patients, multiple organs are involved. 4 The liver is most commonly affected, followed by the peritoneum and lungs.…”

Clinicopathological factors associated with synchronous distant metastasis and prognosis of stage T1 colorectal cancer patients

“…Multivariate survival analyses using Cox proportional hazards models revealed that metastasectomy was signi cantly associated with increased survival in stage T1 colorectal cancer patients with synchronous distant metastasis. The metastasectomy in metastatic colorectal cancer demonstrated the survival bene cial in previous studies [34][35][36][37] . Simultaneous colorectal and minor hepatic resections are considered to be safe for most patients with synchronous liver metastases 38 .…”

Survey on Mental Health Status and Quality of Life and Correlation among Patients with Permanent Stoma of Colorectal Tumor

“…Enterostomy, also known as artificial anus, is a section of intestinal opening artificially flipped and sewn to the abdominal wall incision after resection of the intestinal lesion to replace the function of the anus in order to solve the defecation problem of colorectal cancer patients [ 19 , 20 ]. However, enterostomy causes great inconvenience to patients' life, resulting in great physical and psychological pain, and even affects their compliance with subsequent treatment [ 21 ].…”

“…Although the current implementation of neoadjuvant therapy has reduced the recurrence rate of local lesions and increased the possibility of anus preservation, a considerable number of patients still have local recurrence due to the particularity of the physiological and anatomical location of the colorectal part and the lymphatic drainage pathway [17,18]. Enterostomy, also known as artificial anus, is a section of intestinal opening artificially flipped and sewn to the abdominal wall incision after resection of the intestinal lesion to replace the function of the anus in order to solve the defecation problem of colorectal cancer patients [19,20]. However, enterostomy causes great inconvenience to 3 Computational and Mathematical Methods in Medicine patients' life, resulting in great physical and psychological pain, and even affects their compliance with subsequent treatment [21].…”