Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer

372 Background: The radiological diagnosis of peritoneal carcinomatosis (PC) is challenging. Metastases in the cardiophrenic angle lymph nodes (CPALN) have been anecdotally reported in patients with abdominopelvic malignancies. We aimed to assess whether CPALN detected by computed tomography (CT)-scan are associated with PC in patients with colorectal cancer (CRC). Methods: Between 2007 and 2010, 550 patients with CRC, including 165 (30%) with PC, underwent surgery with complete exploration of the peritoneal cavity in our center. We retrospectively reviewed preoperative CT-scans for the presence of CPALN, and assessed the association of CPALN with surgically confirmed PC by univariate and multivariate analyses. Results: CPALN were present in 123 (75%) of the 165 patients with PC, but absent in 263 (68%) of the 385 patients without PC (sensitivity (Se), 0.72; specificity (Sp), 0.68; positive predictive value (PPV), 0.49; negative PV (NPV), 0.85; odds ratio [OR], 3.3; p<0.001). The presence of CPALN was not correlated with the extent of PC, the primary tumor and lymph node status , or the presence, number, size and location of liver metastases. Among the 165 patients with PC, 99 (60%) had visible signs of PC (other than CPALN) on CT-scan; among the remaining 66 patients, CPALN were the only potential sign of CP in 41 (62%), leading to Se, Sp, PPV, and NPV in patients with no signs of CP (other than CPALN) on CT of 0.62, 0.68, 0.24, and 0.92, respectively. Conclusions: The detection of CPALN on CT may be of valuable help for the diagnosis of PC in patients with CRC.

Download Full-text

Role of Thermal Ablation in Colorectal Cancer Lung Metastases

Cancers ◽

10.3390/cancers13040908 ◽

2021 ◽

Vol 13 (4) ◽

pp. 908

Author(s):

Alexandre Delpla ◽

Thierry de Baere ◽

Eloi Varin ◽

Frederic Deschamps ◽

Charles Roux ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Thermal Ablation ◽

Medical Oncology ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Stereotactic Ablative Radiotherapy ◽

Chest Drainage ◽

Results Of Surgery

Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.

Download Full-text

Nomogram based on homogeneous and heterogeneous associated factors for predicting distant metastases in patients with colorectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02140-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Tianwen Luo ◽

Yutong Wang ◽

Xuefeng Shan ◽

Ye Bai ◽

Chun Huang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lung Metastases ◽

Roc Curves ◽

Distant Metastases ◽

Good Prediction ◽

Operating Characteristics ◽

Good Prediction Performance ◽

Different Types ◽

Associated Risk Factors

Abstract Background The identification of the homogeneous and heterogeneous risk factors for different types of metastases in colorectal cancer (CRC) may shed light on the aetiology and help individualize prophylactic treatment. The present study characterized the incidence differences and identified the homogeneous and heterogeneous risk factors associated with distant metastases in CRC. Methods CRC patients registered in the SEER database between 2010 and 2016 were included in this study. Logistic regression was used to analyse homogeneous and heterogeneous risk factors for the occurrence of different types of metastases. Nomograms were constructed to predict the risk for developing metastases, and the performance was quantitatively assessed using the receiver operating characteristics (ROC) curve and calibration curve. Results A total of 204,595 eligible CRC patients were included in our study, and 17.07% of them had distant metastases. The overall incidences of liver metastases, lung metastases, bone metastases, and brain metastases were 15.34%, 5.22%, 1.26%, and 0.29%, respectively. The incidence of distant metastases differed by age, gender, and the original CRC sites. Poorly differentiated grade, more lymphatic metastasis, higher carcinoembryonic antigen (CEA), and different metastatic organs were all positively associated with four patterns of metastases. In contrast, age, sex, race, insurance status, position, and T stage were heterogeneously associated with metastases. The calibration and ROC curves exhibited good performance for predicting distant metastases. Conclusions The incidence of distant metastases in CRC exhibited distinct differences, and the patients had homogeneous and heterogeneous associated risk factors. Although limited risk factors were included in the present study, the established nomogram showed good prediction performance.

Download Full-text

ctDNA Clearance and Radiographic Resolution of Disease in Response to Dual Checkpoint Inhibition in Metastatic Microsatellite Stable Colorectal Cancer with a High Tumor Mutation Burden

Case Reports in Oncology ◽

10.1159/000516190 ◽

2021 ◽

pp. 849-853

Author(s):

Charles J. Schneider ◽

Michael Krainock ◽

Allyson Koyen Malashevich ◽

Meenakshi Malhotra ◽

Perry Olshan ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Ct Scan ◽

Circulating Tumor Dna ◽

Therapeutic Benefit ◽

Tumor Mutation Burden ◽

Early Treatment Response ◽

Mutation Burden ◽

Disease Present

Immunotherapy (IO) has increasingly been demonstrated to provide therapeutic benefit to patients with metastatic colorectal cancer (mCRC). However, only a subset of mCRC tumors respond to IO. Monitoring response with tumor biomarkers like carcinoembryonic antigen (CEA) has been challenging in patients with microsatellite stable (MSS) mCRC due to low expression of CEA (CEA/lo). Noninvasive blood-based biomarkers such as circulating tumor DNA (ctDNA) can inform early treatment response and augment radiographic monitoring. We describe a case study of a patient with chemotherapy-refractory CEA/lo MSS mCRC, with metastatic disease present in a cardiophrenic lymph node. The patient was given 2 cycles of combination IO (ipilimumab/nivolumab). Response was monitored by ctDNA using a multiplex PCR next-generation sequencing assay, CEA, and CT scan. After IO administration, ctDNA levels rapidly declined, becoming undetectable. This was concurrent with radiographic resolution of the lymph node metastasis. Serial monitoring of CEA during this same period was uninformative, with no significant changes observed. Significant decline in ctDNA identified metastatic response to IO in a patient with CEA/lo, MSS mCRC and was concurrently validated by CT scan. This case study provides evidence that ctDNA can be used as a prospective surrogate for radiographic tumor response.

Download Full-text

Analysis of the prognosis of surgery for colorectal liver metastases by preoperative CT scan images. Could “Central Type” and “Budding phenomenon“ Be Prognostic Factors?

HPB ◽

10.1016/j.hpb.2018.06.2542 ◽

2018 ◽

Vol 20 ◽

pp. S336-S337

Author(s):

K. Hiramatsu ◽

T. Kato ◽

T. Aoba

Keyword(s):

Prognostic Factors ◽

Liver Metastases ◽

Ct Scan ◽

Colorectal Liver Metastases ◽

Central Type ◽

Preoperative Ct

Download Full-text

Outcome of Radical Surgery for Simultaneous Liver and Lung Metastases Synchronous with Primary Colorectal Cancer

Indian Journal of Surgery ◽

10.1007/s12262-021-02848-5 ◽

2021 ◽

Author(s):

Franz Xaver Singhartinger ◽

Martin Varga ◽

Tarkan Jäger ◽

Adam Dinnewitzer ◽

Oliver Koch ◽

...

Keyword(s):

Colorectal Cancer ◽

Lung Metastases ◽

Primary Tumour ◽

Median Number ◽

R0 Resection ◽

Curative Intent ◽

Median Hospital Stay ◽

Free Survival ◽

Colorectal Cancer Patients ◽

Primary Tumour Site

Abstract Background Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The aim of this study is to evaluate the overall (OS) and relapse-free survival (RFS) rates of these patients after resection with curative intent. Methods This study is a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent between May 1st, 2002, to December 31st, 2016, at our institution. Results Colon was the primary tumour site in 2 patients and rectum in 6 patients. The median number of liver and lung metastases was 3 and 2, respectively. Patients received various treatment sequences individualized on tumour disease burden. R0 resection was achieved after all but one procedure. Two severe Clavien-Dindo grade IIIb complications were present. Median hospital stay was 9 (3–24) days per procedure. Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months. Conclusion Our data suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.

Download Full-text