학술논문
Survival outcomes for patients with colorectal cancer with synchronous liver only metastasis.
Document Type
Academic Journal
Author
Shepherdson M; Department of Surgery and Perioperative Medicine, Flinders Medical Center, Adelaide, South Australia, Australia.; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; Kilburn D; Department of Surgery and Perioperative Medicine, Flinders Medical Center, Adelaide, South Australia, Australia.; Ullah S; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; Price T; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.; Karapetis CS; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia.; Nguyen P; Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; Townsend A; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.; Padbury R; Department of Surgery and Perioperative Medicine, Flinders Medical Center, Adelaide, South Australia, Australia.; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; Piantadosi C; Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia.; Maddern G; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.; Carruthers S; Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; Roder D; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.; Sorich M; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; Roy AC; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia.
Source
Publisher: Wiley-Blackwell Publishing Asia Country of Publication: Australia NLM ID: 101086634 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1445-2197 (Electronic) Linking ISSN: 14451433 NLM ISO Abbreviation: ANZ J Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Colorectal cancer with synchronous liver-only metastasis is managed with a multimodal approach, however, optimal sequencing of modalities remains unclear.
Methods: A retrospective review of all consecutive rectal or colon cancer cases with synchronous liver-only metastasis was conducted from the South Australian Colorectal Cancer Registry from 2006 to 2021. This study aimed to investigate how order and type of treatment modality affects overall survival.
Results: Data of over 5000 cases were analysed (n = 5244), 1420 cases had liver-only metastasis. There were a greater number of colon than rectal primaries (N = 1056 versus 364). Colonic resection was the preferred initial treatment for the colon cohort (60%). In the rectal cohort, 30% had upfront resection followed by 27% that had chemo-radiotherapy as 1st line therapy. For the colon cohort, there was an improved 5-year survival with surgical resection as initial treatment compared to chemotherapy (25% versus 9%, P < 0.001). In the rectal cohort, chemo-radiotherapy as the initial treatment was associated with an improved 5-year survival compared to surgery or chemotherapy (40% versus 26% versus 19%, P = 0.0015). Patients who were able to have liver resection had improved survival, with 50% surviving over 5 years compared to 12 months in the non-resected group (P < 0.001). Primary rectal KRAS wildtype patients who underwent liver resection and received Cetuximab had significantly worse outcomes compared to KRAS wildtype patients who did not (P = 0.0007).
Conclusions: Where surgery is possible, resection of liver metastasis and primary tumour improved overall survival. Further research is required on the use of targeted treatments in patients undergoing liver resection.
(© 2023 Royal Australasian College of Surgeons.)
Methods: A retrospective review of all consecutive rectal or colon cancer cases with synchronous liver-only metastasis was conducted from the South Australian Colorectal Cancer Registry from 2006 to 2021. This study aimed to investigate how order and type of treatment modality affects overall survival.
Results: Data of over 5000 cases were analysed (n = 5244), 1420 cases had liver-only metastasis. There were a greater number of colon than rectal primaries (N = 1056 versus 364). Colonic resection was the preferred initial treatment for the colon cohort (60%). In the rectal cohort, 30% had upfront resection followed by 27% that had chemo-radiotherapy as 1st line therapy. For the colon cohort, there was an improved 5-year survival with surgical resection as initial treatment compared to chemotherapy (25% versus 9%, P < 0.001). In the rectal cohort, chemo-radiotherapy as the initial treatment was associated with an improved 5-year survival compared to surgery or chemotherapy (40% versus 26% versus 19%, P = 0.0015). Patients who were able to have liver resection had improved survival, with 50% surviving over 5 years compared to 12 months in the non-resected group (P < 0.001). Primary rectal KRAS wildtype patients who underwent liver resection and received Cetuximab had significantly worse outcomes compared to KRAS wildtype patients who did not (P = 0.0007).
Conclusions: Where surgery is possible, resection of liver metastasis and primary tumour improved overall survival. Further research is required on the use of targeted treatments in patients undergoing liver resection.
(© 2023 Royal Australasian College of Surgeons.)