The impact of primary tumor location in patients with resected colorectal liver metastasis

636 Background: Previous studies have shown that prognosis in metastatic colorectal cancer (mCRC) may vary according to sites of metastasis. We evaluated prognosis in individuals with single site metastasis, according to several clinical and genetic variables. Methods: Using the National Cancer Database we identified 58,044 mCRC patients with a synchronous single site of metastasis. We first examined the effect of metastasis site on prognosis. In a secondary analysis, among individuals who had not undergone surgery or received radiotherapy, we examined the prognostic value of chemotherapy intensity, KRAS status, primary tumor location and CEA levels. Results: Individuals with lung metastasis had the best prognosis (HR = 0.80, 0.77-0.83), followed by those with liver metastasis (HR = 1.11, 1.07-1.15), while those with bone or brain metastasis had the worse prognosis. In a subgroup analysis, we assessed prognosis among individuals who received multi-agent chemotherapy and had not undergone surgery or received radiotherapy. Individuals with lung metastasis and mutant KRAS had better prognosis compared with those with liver metastasis, (HR = 0.69, 0.54-0.88), regardless of primary tumor location or CEA levels. Conclusions: Single site metastasis to the lungs is associated with better prognosis in mCRC, specifically among KRAS mutant tumors. This survival advantage should be taken into consideration in clinical decision-making.

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Clinical Impact of Primary Tumor Location in Metastatic Colorectal Cancer Patients Under Later-Line Regorafenib or Trifluridine/Tipiracil Treatment

Frontiers in Oncology ◽

10.3389/fonc.2021.688709 ◽

2021 ◽

Vol 11 ◽

Author(s):

Hiromichi Nakajima ◽

Shota Fukuoka ◽

Toshiki Masuishi ◽

Atsuo Takashima ◽

Yosuke Kumekawa ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Predictive Factor ◽

Primary Tumor ◽

Group Performance ◽

Univariate Analysis ◽

Tumor Location ◽

Clinical Impact ◽

Primary Tumor Location ◽

The Impact

BackgroundPrimary tumor location (PTL) is an important prognostic and predictive factor in the first-line treatment of metastatic colorectal cancer (mCRC). Although regorafenib (REG) and trifluridine/tipiracil (FTD/TPI) have been introduced recently, the clinical impact of PTL in these treatments is not well understood.Materials and MethodsWe retrospectively evaluated patients with mCRC who were registered in a multicenter observational study (the REGOTAS study). The main inclusion criteria were Eastern Cooperative Oncology Group performance status (ECOG PS) of 0–2, refractory or intolerant to fluoropyrimidines, oxaliplatin, irinotecan, angiogenesis inhibitors, anti-epidermal growth factor receptor therapy (if RAS wild-type), and no prior use of REG and FTD/TPI. The impact of PTL on overall survival (OS) was evaluated using Cox proportional hazard models based on baseline characteristics.ResultsA total of 550 patients (223 patients in the REG group and 327 patients in the FTD/TPI group) were included in this study, with 122 patients with right-sided tumors and 428 patients with left-sided tumors. Although the right-sided patients had significantly shorter OS compared with the left-sided patients by univariate analysis (p = 0.041), a multivariate analysis revealed that PTL was not an independent prognostic factor (hazard ratio, 0.95; p = 0.64). In a subgroup analysis, the OS was comparable between the REG and FTD/TPI groups regardless of PTL (p for interactions = 0.60).ConclusionsIn the present study, PTL is not a prognostic and predictive factor in patients with mCRC under later-line REG or FTD/TPI therapy.

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Relationship between primary tumor location and prognosis in metastatic colorectal cancer patients treated with irinotecan/5-FU/leucovorin (FOLFIRI).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.557 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 557-557 ◽

Cited By ~ 1

Author(s):

Qianqian Yu ◽

Hong Qiu ◽

Mingsheng Zhang ◽

Xianglin Yuan

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Median Survival ◽

Survival Probability ◽

Primary Tumor ◽

Statistical Significance ◽

Tumor Location ◽

First Line ◽

Primary Tumor Location ◽

The Impact

557 Background: Clinical trials including CALGB/SWOG 80405 and FIRE-3 reveal differences in overall survival (OS) for metastatic colorectal cancer (mCRC) patients treated with targeted therapy based on primary tumor location. We assessed the impact of tumor location on prognosis in a prospective series of patients with mCRC received FOLFIRI in first-line therapy. Methods: Patients treated with FOLFIRI were consecutively recruited between November 2010 and December 2014. Follow-up information was updated in February 2016 when 77.3% of the patients were deceased. We defined the right-sided colon = cecum to transverse colon, left-sided colon = splenic flexure to sigmoid descending colon, rectum = rectosigmoid plus rectal cancer, respectively. We measured median survival using Kaplan-Meier plots and 2-year survival probability using life tables. Associations between tumor locations and treatment outcomes were estimated using a Cox proportional hazards model. Age and gender were included in adjusted Cox models to estimate the hazard ratio (HR) for death of rectal and left-sided tumors relative to right-sided tumors. Results: Right-sided cancer had a shorter median survival (13.5 vs. 20.4 months) and worse 2-year survival probability (28% vs. 39%) than left-sided and rectal cancers, however the difference was of no statistical significance no matter in unadjusted (HR = 1.002, 95% CI 0.635-1.581) or adjusted models (HR = 1.037, 95% CI 0.657-1.639). Conclusions: mCRC patients with right-sided colon got comparative survival benefit from FOLFIRI in first-line treatment to the left-sided colon and rectum. This result needs to be validated in studies with larger sample size. Clinical trial information: NCT01282658.

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Clinical impact of primary tumor location in patients with metastatic colorectal cancer (mCRC) treated with regorafenib or trifluridine/tipiracil as later-line.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.105 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 105-105

Author(s):

Hiromichi Nakajima ◽

Shota Fukuoka ◽

Toshikazu Moriwaki ◽

Toshiki Masuishi ◽

Atsuo Takashima ◽

...

Keyword(s):

Rectal Cancer ◽

Prognostic Factor ◽

Propensity Score ◽

Propensity Score Matching ◽

Primary Tumor ◽

Univariate Analysis ◽

Tumor Location ◽

Primary Tumor Location ◽

The Right ◽

The Impact

105 Background: In the recent years, primary tumor location (PTL) is considered as an important prognostic and predictive factor in first-line treatment of mCRC. Although regorafenib (REG) and trifluridine/tipiracil (TFTD) have been available recently, the prognostic value of PTL in later-line with these agents is not well understood. TFTD improved survival regardless of PTL in the RECOURSE trial, while REG did not show survival benefit in the patients (pts) with rectal cancer in the CORRECT trial. Methods: We retrospectively evaluated pts with mCRC who were registered in a multicenter observational study (the REGOTAS study). The main inclusion criteria were ECOG PS of 0–2, refractory or intolerant to fluoropyrimidines, oxaliplatin, irinotecan, and anti-VEGF and anti-EGFR therapy (if KRAS wild type), and no prior use of REG and TFTD. The impact of PTL on overall survival (OS) were evaluated using Cox proportional hazards models based on baseline characteristics and propensity score matching. Results: A total of 550 pts (223 pts in the REG group, 327 pts in the TFTD group; 122 pts in the right-sided, 428 pts in the left-sided) were included in this study. Although the right-sided pts was significantly shorter OS compared with the left-sided pts by univariate analysis (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.63-0.99, P = 0.04), multivariate analysis revealed that PTL was not an independent prognostic factor (HR 0.88, 95% CI 0.69-1.1, P = 0.26). The similar results were obtained in each treatment group. In subgroup analysis according to PTL, OS were comparable between REG and TFTD groups regardless of PTL (HR 0.93, 95% CI 0.62-1.39 in the right-sided; HR 1.08, 95% CI 0.83-1.39 in the left-sided [excluding rectum]; and HR 1.01, 95% CI 0.62-1.62 in the rectal cancer pts). These results were similar in sensitivity analysis using propensity score-matching. Conclusions: In the present study, PTL is not a prognostic factor in patient with mCRC treated with either REG or TFTD as later-line. No difference in OS was observed between REG and TFTD groups irrespective of PTL.

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