6054 Management of isolated non-resectable liver metastases in colorectal cancer patients: a case-control study of isolated hepatic perfusion with melphalan versus systemic chemotherapy

Objective: Whether an association between oral levothyroxine use, leading to supraphysiological exposure of the colon to thyroid hormones, and risk of colorectal cancer exists in humans is unclear. We therefore aimed to assess whether the use of levothyroxine is associated with a reduced risk of colorectal cancer in a linked cohort of pharmacy and cancer data. Design: Population-based matched case-control study. Methods: A total of 28,121 patients diagnosed with colorectal cancer between 1998-2014 were matched to 106,086 controls. Multivariable logistic regression was used to estimate the association between levothyroxine use and occurrence of colorectal cancer, adjusted for potential confounders. Results were stratified by gender, age, tumour subtype and staging as well as treatment duration and dosing. Results: A total of 1066 colorectal cancer patients (4%) and 4024 (4%) controls had used levothyroxine at any point before index date (adjusted odds ratio 0.95 [0.88-1.01]). Long-term use of levothyroxine was seen in 323 (30%) colorectal cancer patients and 1111 (28%) controls (adjusted odds ratio 1.00 [0.88-1.13]). Stratification by tumour subsite showed a borderline significant risk reduction of rectal cancer, while this was not seen for proximal colon cancer or distal colon cancer. There was no relationship with treatment duration or with levothyroxine dose. Conclusions: In this study, no reduced risk of colorectal cancer was seen in levothyroxine users. When stratifying by tumour subsite, a borderline significant risk reduction of rectal cancer was found and may warrant further research.

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Should patients with peritoneal carcinomatosis of colorectal origin with synchronous liver metastases be treated with curative intent? A case-control study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14158 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14158-e14158

Author(s):

Goere Diane ◽

Leon Maggiori ◽

Benjamin Viana ◽

Frédéric Dumont ◽

Charles Honoré ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Peritoneal Carcinomatosis ◽

Intraperitoneal Chemotherapy ◽

Case Control Study ◽

Case Control ◽

Prognostic Impact ◽

Primary Colorectal Cancer ◽

Matching Criteria ◽

Control Study

e14158 Background: This aim of this case-control study was to assess the prognostic impact of the presence of liver metastases (LM) in patients operated on colorectal peritoneal carcinomatosis (PC) who underwent complete cytoreductive surgery (CRS) and LM resection followed by intraperitoneal chemotherapy. Methods: From a prospectively maintained database, all patients with colorectal PC and synchronous LM who underwent CRS followed by intraperitoneal chemotherapy, were manually matched to all identical patients with isolated PC, operated on over the same period, on the following matching criteria: age, peritoneal cancer index (PCI), site of the primary colorectal cancer (colon or rectum), lymph node involvement on the primary colorectal cancer specimen (pN), and postoperative chemotherapy. Results: From 1993 to 2009, 37 patients with PC and LM were matched to 61 patients with isolated PC. After a mean follow-up of 36 months, 3-year overall (OS) and disease free survival rates were significantly lower in patients with PC and LM, respectively 40% and 66% (p=0.04) and 6% and 27% (p=0.001). In Cox regression analysis, a PCI ≥ 12 (Odds-ratio (OR): 4.6), a pN+ status (OR: 3.3), no adjuvant chemotherapy (OR: 3.0) and presence of LM (OR: 2.0) were identified as independent factors of poor OS. Thus, 3 groups could be identified: 1) patients with a low PCI (<12) and no LM, with an associated a median OS of 76 months; 2) patients with a low PCI (<12) and 1 or 2 LM, with an associated OS of 40 months; and 3) patients with a high PCI (≥12) or patients with ≥ 3 LM, with an associated OS of 27 months. Conclusions: This first case-control study confirms that prolonged survival can be achieved in highly selected patients operated on limited carcinomatosis and liver metastases less than 3. When the peritoneal and the liver involvement are greater, the complete surgical treatment followed by intraperitoneal chemotherapy should be discussed according to criteria of aggressiveness of the tumor disease.

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