scholarly journals Association between Fusobacterium nucleatum and patient prognosis in metastatic colon cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jii Bum Lee ◽  
Kyung-A Kim ◽  
Ho Yeon Cho ◽  
DooA Kim ◽  
Won Kyu Kim ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Quantitative Polymerase Chain Reaction ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Fusobacterium Nucleatum ◽  
Metastatic Colon Cancer ◽  
Fresh Tissue ◽  
Colon Cancers ◽  
Formalin Fixed Paraffin Embedded ◽  
Patient Prognosis

AbstractRecent evidence suggests that Fusobacterium nucleatum (Fn) is associated with the development and progression of colorectal cancer. We aimed to delineate the clinical implications of Fn in metastatic colon cancer. We performed quantitative polymerase chain reaction (qPCR) using DNA samples from synchronous metastatic colon cancer patients with either formalin-fixed paraffin-embedded (FFPE) archival primary site tumor samples or fresh colon tissues. Progression-free survival (PFS)1 and PFS2 were defined as PFS of first- and second-line palliative settings. qPCR for Fn was successfully performed using 112 samples (FFPE, n = 61; fresh tissue, n = 51). Forty-one and 68 patients had right-sided and left-sided colon cancer, respectively. Patients with Fn enriched right-sided colon cancers had shorter PFS1 (9.7 vs. 11.2 months) than the other subgroups (HR 3.54, 95% confidence interval [CI] 1.05–11.99; P = 0.04). Fn positive right-sided colon was also associated with shorter PFS2 (3.7 vs. 6.7 months; HR 2.34, 95% CI 0.69–7.91; P = 0.04). In the univariate analysis, PFS1 was affected by differentiation and Fn positive right-sided colon cancer. The multivariate analysis showed that differentiation (HR 2.68, 95% CI 1.40–5.14, P = 0.01) and Fn positive right-sided colon (HR 0.40, 95% CI 0.18–0.88, P = 0.02) were associated with PFS1. Fn enrichment in right sided colon was not associated with overall survival (OS). Fn enrichment has significantly worse prognosis in terms of PFS1 and PFS2 in patients with right-sided metastatic colon cancers.

scholarly journals RIPK3 expression as a potential predictive and prognostic marker in metastatic colon cancer

2019 ◽  
Vol 42 (1) ◽  
pp. E31-E38 ◽  
Author(s):  
Nikolay V. Conev ◽  
Eleonora G. Dimitrova ◽  
Margarita K. Bogdanova ◽  
Yavor K. Kashlov ◽  
Borislav G. Chaushev ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cell Death ◽  
Cancer Patients ◽  
Prognostic Marker ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
High Expression ◽  
Metastatic Colon Cancer ◽  
Primary Tumors ◽  
Low Expression

Background: Colorectal cancer is one of the primary causes of cancer-related deaths and 5-fluorouracil (5-FU) therapy remains the cornerstone of treatment in these patients. Resistance to 5-FU represents a major obstacle; therefore, finding new predictive and prognostic markers is crucial for improvement of patient outcomes. Recently a new type of programmed cell death was discovered—necroptosis, which depends on receptor interacting protein 3 (RIPK3). Preclinical data showed that necroptotic cell death is an important effector mechanism of 5-FU-mediated anticancer activity. Purpose: To investigate the predictive and prognostic performance of RIPK3 expression in primary tumors. Methods: Colon cancer patients (n=74) with metastatic stage were included in this retrospective study and all were treated with first-line 5-FU based chemotherapy. Immunohistochemical staining was performed. Results: The progression free survival for the low expression group of RIPK3 was 5.6 months (95% CI, 4.4-6.8) vs 8.4 months (95% CI, 6.4-10.3) of the group with high expression (p=0.02). Moreover, patients with high expression of RIPK3 were associated with lower risk of disease progression HR 0.61 (95% CI, 0.38-0.97; p=0.044). Patients with high expression levels of RIPK3 also had significantly longer mean overall survival (OS) of 29.3 months (95% CI, 20.8-37.8) as compared with those with low expression: 18.5 months (95% CI, 15.06-21.9) (p= 0.036). In addition, univariate analysis showed that high level of RIPK3 expression was associated with a longer OS HR 0.59 (95% CI, 0.35-0.98; p=0.044). Conclusions: This study suggests that expression of RIPK3 in primary tumors of metastatic colon cancer patients should be further investigated for its potential as a promising predictive and prognostic marker.

Outcome of colon cancer patients with synchronous metastases

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4029-4029
Author(s):  
I. Sobhani ◽  
F. Roudot-Thoraval ◽  
F. Mesli ◽  
B. Landi ◽  
T. Aparicio ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Cox Model ◽  
Univariate Analysis ◽  
Colon Surgery ◽  
Teaching Hospitals ◽  
Rank Test ◽  
Metastatic Colon Cancer ◽  
Curative Surgery ◽  
Synchronous Metastases

4029 Background: Metastatic colon cancer patients may undergo chemotherapy without colon surgery. However, the outcome of patients has not been evaluated and antiagiogenic agents can not be given. The aim of the present cohort study was to analyse factors influencing patients’ survival. Methods: Consecutive patients [N=228, mean age (sd) 64 (12) yrs, median follow-up 20 mths;84 females] treated in 6 teaching hospitals received chemotherapy for metastatic colonic cancer, either as the first step, or after surgery. Progressive free survival (PFS) was estimated using Kaplan-Meïer method. Factors associated with PFS were tested by means of Log rank test and results are presented in terms of medians of survival (95% CI). Factors independently related to PFS were tested using a Cox model and results are presented as hazard ratio. Results: 105 patients with colon cancer and synchronous metastatsis underwent colon surgery prior to chemotherapy (68 males, mean age 64 yrs) when 123 patients were treated first by chemotherapy ± biotherapy (76 males, mean age 63 yrs). By univariate analysis, following factors were significantly associated with PFS: surgery first 25.5 (18.6 - 32.5) vs chemotherapy first 18.3 (14.7 - 21.9) mths p = 0.006; curative surgery: yes 35.7 (29.6 - 41.8) vs no 18.4 (15.6 - 21.2) mths p < 0.001; tumour histological differentiation : no : 13.4 (6.2 - 20.6) vs well : 24.7 (20.4 - 29.1) mths p<0.001; synchronous metastases: liver only 25.5 (20.5 - 30.6) vs peritonea&nodes : 18.4 (10.6 - 26.1) vs pulmonary & other sites : 16.5 (14.7 - 18.3) mths p < 0.0001; need for colonic stent: yes 16.4 (9.3 - 23.5) vs no 23.9 (21.1 - 26.7) months p < 0.0001; antiangiogenic drug: yes 36.6 (28.7 - 44.5) vs no : 20.7 (18.3 - 23.1) p = 0.033. After Cox multivariate analysis five independent factors were found to be associated with PFS. Conclusions: Colon surgery before chemotherapy plus bevacizumab appears to be the more appropriate choice, and associated with longer PFS, especially for those patients with well differentiated tumours and synchronous liver metastases. [Table: see text] No significant financial relationships to disclose.

5-flourouracil (5FU) shortage: Clinical implications and costs in a single month.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 663-663 ◽  
Author(s):  
Shweta Gupta ◽  
Prantesh Jain ◽  
Saurabh Gupta ◽  
Barbara Yim ◽  
Michael Russell Mullane
Keyword(s):  
Colon Cancer ◽  
Adverse Effects ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Wholesale Price ◽  
Progression Free Survival ◽  
The Body ◽  
Colon Cancers ◽  
Number Of Cycles

663 Background: Capecitabine (XELODA) is an orally active fluoropyrimidine that is absorbed intact through the gastrointestinal tract and converted in to 5FU. Standard chemotherapy for advanced colon cancers includes infusional 5FU with leucovorin in combination of oxaliplatin (FOLFOX) or irinotecan (FOLFIRI). With the national shortage of 5FU we had to switch our FOLFOX and FOLFIRI regimens to XELOX or XELIRI. Although in trials the xeloda regimens were non-inferior, the PFS (progression free survival) and OS (overall survival), survival curves tailed behind the infusional 5FU regimens. Methods: At our institution over one month period from August 18th 2011 to September 18th 2011, all patients who were switched from 5FU to xeloda due to national shortage were identified. All charts were retrospectively reviewed identifying patients with colon cancer. Patients with other cancer histologies, were excluded. The charts were reviewed for number of cycles, clinical toxicity, admission to hospital. Results: A total of 90 patients were switched form 5FU to xeloda. 51 had colon cancer. Out of which, 6 (11.7%) patients had the drug discontinued due to toxicity and 4 out of the 6 required hospitalization due to adverse effects of xeloda, mainly diarrhea and vomiting. 80% of these had left sided colon cancer and 50% each received oxaliplatin and irinotecan respectively. The total number of hospitalization days was 20. The average wholesale price (AWP) of one cycle of xeloda for body surface area range from 1.5m2 to 2m2 ranges from 2605.68$ to 3474.24$ for every 3 week cycle. In comparison the corresponding AWP for 2 cycles of 5FU over a month is 51.81$ to 69.08$. This would become a net higher price of 2553.87$ to 3405.16$ for BSA of 1.5 to 2m2 per month for the switch to xeloda. There were 51 patients who received xeloda at least one cycle which costed about 151,954.50$ if we average the body surface area. Additionally there were 20 admission days costing about 50,000$, making the net costs of switching to xeloda more than 200,000$ in a single month. Conclusions: Although xeloda is non-inferior to 5FU and can be a substitute, left sided colon cancers tend to do have more adverse effects. Additionally Xeloda is associated with higher administration costs.

scholarly journals Emergency Presenting Colon Cancer Is an Independent Predictor of Adverse Disease-Free Survival

2015 ◽  
Vol 100 (1) ◽  
pp. 77-86 ◽  
Author(s):  
John Hogan ◽  
Georges Samaha ◽  
John Burke ◽  
Kah Hoong Chang ◽  
Eoghan Condon ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Locoregional Recurrence ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Free Survival ◽  
Emergency Presentation ◽  
Colon Cancers ◽  
Analysis Survival ◽  
Disease Free

Abstract Twenty percent of colon cancers present as an emergency. However, the association between emergency presentation and disease-free survival (DFS) remains uncertain. Consecutive patients who underwent elective (CC) and emergent (eCC) resection for colon cancer were included in the analysis. Survival outcomes were compared between the 2 groups in univariate/multivariate analyses. A total of 439 patients underwent colonic resection for colon cancer during the interval 2000−2010; 97 (22.1%) presented as an emergency. eCC tumors were more often located at the splenic flexure (P = 0.017) and descending colon (P = 0.004). The eCC group displayed features of more advanced disease with a higher proportion of T4 (P = 0.009), N2 tumors (P &lt; 0.01) and lymphovascular invasion (P&lt; 0.01). eCC was associated with adverse locoregional recurrence (P = 0.02) and adverse DFS (P &lt; 0.01 ) on univariate analysis. eCC remained an independent predictor of adverse locoregional recurrence (HR 1.86, 95% CI 1.50–3.30, P = 0.03) and DFS (HR 1.30, 95% CI 0.88–1.92, P = 0.05) on multivariate analysis. eCC was not associated with adverse overall survival and systemic recurrence. eCC is an independent predictor of adverse locoregional recurrence and DFS.

Amphiregulin (AREG) expression and response to first-line panitumumab (pmab) plus FOLFIRI in metastatic colorectal cancer (mCRC).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 731-731
Author(s):  
Claus-Henning Kohne ◽  
Ralf Hofheinz ◽  
Laurent Mineur ◽  
Henry Letocha ◽  
Richard Greil ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Quantitative Polymerase Chain Reaction ◽  
Objective Response ◽  
Growth Factor Receptor ◽  
Treatment Decision ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
First Line ◽  
Treatment Benefit ◽  
Formalin Fixed Paraffin Embedded

731 Background: Biomarker analyses have shown that patients (pts) with RAS wild-type (WT) mCRC can achieve overall survival (OS) benefits with first-line pmab plus chemotherapy. Other biomarkers may exist that could optimize pt selection. Epidermal growth factor receptor ligand (eg AREG) levels have been correlated with OS during anti-EGFR therapy. Here we investigate the relationship between AREG expression and treatment outcome in a single-arm first-line mCRC study of pmab + FOLFIRI. Methods: Qualified reverse transcription quantitative polymerase chain reaction (RT-qPCR) assays were used to measure AREG RNA expression in archival formalin-fixed, paraffin embedded tumor samples from mCRC pts in two pmab trials (STEPP and 314). The STEPP analysis was used to establish a cut-off point in AREG expression that identified the best responders. This cut-off was applied prospectively to samples previously analyzed for KRAS in the 314 trial. Using the KRASMT subgroup as a non-responding comparator, Cox proportional hazards (PH) models were used to evaluate AREG expression levels as a continuous covariate. Decision curves were used to estimate the progression-free survival (PFS) hazard ratio (HR) with increasing levels of baseline AREG expression. Results: In the 314 trial 100 pts had evaluable AREG levels. Among 50 KRAS WT pts, high AREG expression was associated with objective response (OR) (Table). The high AREG group had better PFS HRs (KRAS WT/KRAS MT: 0.30 [95% CI, 0.12–0.75]) compared with the low AREG group (PFS HR 0.49 [95% CI 0.21–1.1]). There was a significant biomarker-by-AREG expression interaction in the Cox PH model (p=0.03). Conclusions: Treatment decision curves based on the PH model suggest that most KRAS WT patients express AREG at levels where treatment benefit is predicted. Future analysis of samples from a RASWT population may provide further insights. Clinical trial information: NCT00508404. [Table: see text]

Palliative oxaliplatin-based chemotherapy after exposure to oxaliplatin in the adjuvant setting for colon cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 753-753
Author(s):  
Renata D'Alpino Peixoto ◽  
Aalok Kumar ◽  
Sharlene Gill ◽  
Howard John Lim
Keyword(s):  
Colon Cancer ◽  
Progression Free Survival ◽  
Population Based ◽  
Stage Iii ◽  
Metastatic Colon Cancer ◽  
Stage Iii Colon Cancer ◽  
Metastatic Setting ◽  
Cancer Agency ◽  
Third Line

753 Background: Little is known regarding the efficacy of oxaliplatin-based chemotherapy for metastatic colon cancer patients who have already received adjuvant oxaliplatin-based chemotherapy. Methods: We retrospectively reviewed 22 consecutive patients who developed recurrence after adjuvant oxaliplatin-based chemotherapy for stage III colon cancer and received another course of oxaliplatin-based chemotherapy for their metastatic disease. The main endpoint was progression-free survival (PFS). Results: 635 patients received oxaliplatin-based chemotherapy for stage III colon cancer at the British Columbia Cancer Agency from 2006 to 2011. 176 pts recurred, 22 (12.5%) of whom were re-exposed to oxaliplatin in the metastatic scenario. Oxaliplatin in combination with fluoropyrimidine was given as first line in 3 pts (13.6%), as second line in 14 (63.6%), and third line in 5 (22.7%). Median time from the last cycle of adjuvant oxaliplatin-based chemotherapy to the first cycle of palliative oxaliplatin-based chemotherapy was 44.3 months. Median PFS and OS were 3.3 (95% CI 1.4-5.1) and 10.0 months (95% CI 5.3-14.6), respectively. There was no difference in PFS for patients who were re-exposed to oxaliplatin in less than 36 months or later than that (3.6 versus 3.1 months, p=0.793, HR=0.88). Conclusions: In this population-based study, only a small proportion of pts who recurred after oxaliplatin-based adjuvant therapy received oxaliplatin in the metastatic setting. Re-exposure of oxaliplatin in combination with fluoropyrimidine is associated with only modest PFS benefit. Larger studies evaluating the role of oxaliplatin re-exposure are needed.

scholarly journals Risk Factors for Venous Thromboembolism in Metastatic Colon Cancer Patients in the Contemporary Treatment Era: A SEER-Medicare Data Analysis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2598-2598 ◽  
Author(s):  
Bhargavi Pulluri ◽  
Benjamin Littenberg ◽  
Inder Lal ◽  
Chris E. HOlmes ◽  
Steven Ades
Keyword(s):  
Risk Factors ◽  
Colon Cancer ◽  
Venous Thromboembolism ◽  
Age At Diagnosis ◽  
Metastatic Colon Cancer ◽  
Urban Residence ◽  
Comorbidity Score ◽  
Colon Cancers ◽  
Medicare Data ◽  
Charlson Comorbidity Score

Abstract Background:The relationship between metastatic colorectal cancer (CRC) and venous thromboembolism (VTE) is not well defined in the modern treatment era. Previous population-based studies date back to a period marked by inpatient intravenous heparin therapy and inferior survival due to paucity of therapeutic anti-cancer options, and before the advent of newer therapies including oxaliplatin, irinotecan, and anti-angiogenic treatment with bevacizumab. The objectives of this retrospective study were to examine the impact of multiple putative risk factors on VTE incidence in a large representative modern cohort of older patients with metastatic CRC. Methods:We performed a retrospective analysis of SEER-Medicare data on elderly patients with metastatic CRC diagnosed in 2004-2011. VTE and associated risk factors were analyzed using multivariate Cox proportional hazards models adjusted for sex, age at diagnosis, race, ethnicity, tumor anatomy (left/right/unknown), calendar year of diagnosis, Charlson comorbidity score, location of SEER registry and urban residence, with time-varying covariates for use of cancer therapies. Results:Of 339,778 records, 11,086 metastatic colon cancer cases were identified. 1,338 cases had VTE with a cumulative incidence of 13% at 1 year and 19% at 3 years. The mean age was 77.9 years (range 65-106). 49.7% were women and 83.5% white. 60.5% had a Charlson comorbidity score of zero at diagnosis; 6% had scores of 6-18. Significant predictors of VTE included female sex (Hazard Ratio (HR) 1.22; 95% Confidence Interval (CI) 1.10, 1.36; P<0.001), younger age at diagnosis (HR 1.25 per decade of age; CI 1.15, 1.37; P<0.001), urban residence (HR 1.20; CI 1.03, 1.40; P=0.02), right sided colon cancers (HR 1.19; CI, 1.06, 1.33 P=0.003), and current use of 5-fluorouracil (HR 1.33; CI 1.04, 1.70; P=0.02). The risk of VTE was significantly reduced when on bevacizumab (HR 0.77; CI 0.63, 0.93; P=.006), or irinotecan therapy (HR 0.59; CI 0.47, 0.75; P<0.001) and in those with more comorbid conditions (HR 0.97 per point of Charlson score; CI 0.935, 0.998; P=0.04). Conclusion: The higher incidence of VTE seen in right sided colon cancers may be related to biologically aggressive tumors associated with poor survival as reported in recent studies. The lower risk of VTE in older, sicker patients was unexpected and may reflect the effect of competing mortality. In this large contemporary cohort, anti-angiogenic therapy was not associated with a higher risk of VTE; the apparent protective effects of bevacizumab and irinotecan may represent treatment assignment bias. Disclosures No relevant conflicts of interest to declare.

scholarly journals FOLFOXIRI in patients with colon cancer and isolated non-resectable liver metastases: phase II prospective non-randomized single-center study

2019 ◽  
Vol 9 (4) ◽  
pp. 21-31 ◽  
Author(s):  
M. Yu. Fedyanin ◽  
E. M. Polyanskaya ◽  
I. A. Pokataev ◽  
A. A. Tryakin ◽  
O. V. Sekhina ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Liver Metastases ◽  
Objective Response ◽  
Progression Free Survival ◽  
Metastatic Colon Cancer ◽  
Single Center ◽  
Free Survival ◽  
Liver Resections ◽  
Length Of Life

Objective: to assess the frequency of liver resections in patients with metastatic colon cancer and isolated non-resectable liver metastases receiving FOLFOXIRI. Materials and methods. In this single-center non-randomized prospective study, we assessed the frequency of liver resections. According to the statistical hypothesis, the frequency of R0-resections in patients with metastatic colon cancer receiving FOLFOXIRI is between 11 % and 33 % (mean 20 %); to increase it up to 50 % in patients with isolated metastatic lesions in the liver, we had to recruit 20 patients (with β = 0.9 and a = 0.05). We enrolled 20 patients with potentially resectable metastases and 22 patients with non-resectable metastases. The primary endpoint was the frequency of R0 liver resections; secondary endpoints included objective response rate, progression-free survival, overall survival, and tolerability of therapy. Patients receiving targeted therapy (according to the tumor mutation status) were also included in the study.Results. Objective response was observed in 32 out of 42 patients (76 %) (in 17 out of 20 participants (85 %) with potentially resectable metastases), whereas progressive disease was registered in 2 patients (5 %). Radical resection of organs affected by metastasis was performed in 19 out of 42 patients (45 %): 15 out of 20 (75 %) in the group with potentially resectable metastases and 4 out of 22 (18 %) in the group with non-resectable metastasis (р <0.01). At a median follow-up of 11 months (range: 1–32 months), median progression-free survival was 10 months (95 % confidence interval (CI) 8.9–11.1), while median length of life was 34 months (95 % CI 21.3–46.7). Median overall survival was 34 months in patients that had undergone metastasectomy vs 19 months in patients that had no metastasectomy (hazard ratio 0.7; 95 % CI 0.01–0.70; p = 0.02).Conclusions. FOLFOXIRI increased the frequency of metastasectomy in patients with potentially resectable liver metastases from colon cancer, which was associated with a pronounced increase in the length of life. 

scholarly journals Malignant pericardial effusion as a primary manifestation of metastatic colon cancer: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Milena Brachmans Mascarenhas Neves ◽  
Mirella Velasco Stival ◽  
Yuri Costa Sarno Neves ◽  
Jordânia Gonçalves Pereira da Silva ◽  
Daniela Borges da Rocha Macedo ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Pericardial Effusion ◽  
Sudden Onset ◽  
Metastatic Colon Cancer ◽  
Primary Tumors ◽  
Case Presentation ◽  
Malignant Pericardial Effusion ◽  
Colon Cancers ◽  
Diagnostic Hypothesis ◽  
Pericardial Metastasis

Abstract Background Pericardial neoplastic involvement is rarely related to primary tumors of the pericardium and is most often caused by spread from other primary sites, such as lung and breast carcinomas, hematological malignancies (lymphoma and leukemia), and melanoma. Although pericardial metastasis from infradiaphragmatic tumors (such as colon cancers) are rare and poorly described in literature, any neoplasm has the potential to metastasize to the pericardium and heart by either contiguity, lymphatic, or hematological spread. Case presentation A 44-year-old previously healthy male Causasian patient had a sudden onset of dyspnea and wheezing. During investigation with echocardiogram, computed tomography and repeated pericardiocentesis, the cause of malignant pericardial effusion was confirmed as primary manifestation of metastatic colon cancer. The patient was treated with appropriate chemotherapy and presented satisfactory disease control. Conclusions This report emphasizes the importance of considering the diagnostic hypothesis of occult neoplasia in a patient with pericardial effusion.

Right versus left: Impact of primary location on survival and cure in patients undergoing hepatic resection for metastatic colon cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 664-664 ◽  
Author(s):  
John M. Creasy ◽  
Eran Sadot ◽  
Bas Groot Koerkamp ◽  
Joanne F. Chou ◽  
Mithat Gonen ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Hepatic Resection ◽  
Cox Regression ◽  
Progression Free Survival ◽  
Lymph Node Status ◽  
Metastatic Colon Cancer ◽  
Primary Tumors ◽  
Free Survival ◽  
Primary Location ◽  
Cure Rates

664 Background: Recent prospective studies in metastatic colorectal cancer (mCRC) have demonstrated an association between left-sided primaries and improved overall (OS) and progression-free survival (PFS). Primary location (right vs left colon) has not been well studied in patients undergoing potentially curative hepatic resection. Methods: A single-institution database was queried for all initial hepatic resections for mCRC 1992-2004. Postoperative deaths and patients with no followup after 90 days were excluded. Primary location determined by chart review (Right = cecum to transverse; Left = splenic flexure to sigmoid). Rectal cancer (distal 16cm), multiple primaries, and unknown location were excluded. Kaplan Meier and Cox regression methods were used. Cure was defined as actual 10-year survival with no recurrence or resected recurrence with at least 3 years of disease-free followup. Results: 907 patients were included with a median followup of 11 years. 578 patients (64%) had left-sided and 329 (36%) had right-sided primary. Median OS for patients with a left-sided primary was 5.2 years (95% CI: 4.6-6.0) versus 3.6 years (95% CI: 3.2-4.2) for right-sided (p = 0.004). The hazard ratio (HR) for right-sided tumors was 1.22 (95% CI: 1.02-1.45, p = 0.028) after adjusting for age, CEA > 200, DFI < 12 months, hepatic tumor > 5cm, > 1 tumor, lymph node status, margin, and extrahepatic disease. Recurrence-free survival (RFS) was marginally different stratified by primary location (p = 0.065). Estimated cure rates were 22% for left and 20% for right-sided tumors. Conclusions: Among patients selected for hepatic resection of metastatic colon cancer, left-sided primary tumors were associated with an improved OS but not RFS. This difference in OS was independent of common prognostic variables. Estimated cure rates were not statistically different. Patients with left-sided primary tumors display a prolonged clinical course after recurrence suggestive of more indolent biology. [Table: see text]

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