Early PET/CT scan compared with RECIST to predict long-term outcome of patients with liver metastases from colorectal cancer treated with preoperative chemotherapy plus bevacizumab.

11008 Background: Early changes in tumor metabolism measured with positron-emission-tomography/computerized tomography (PET/CT) could predict the long-term efficacy of treatment better than dimensional RECIST response. Methods: We performed PET/CT before and after 1 cycle of treatment in patients with resectable liver metastases from colorectal cancer, within a phase II trial of preoperative FOLFIRI plus bevacizumab. For each lesion, the maximum SUV (SUVmax) and the total lesion glycolisis (TLG) were determined. For both, based on previous studies, a ≤-50% change from baseline was used as threshold for significant response. Metabolic response was categorized no/yes by using three different methods that enter into the calculation (i) the largest observed value (highest SUVmax/TLG), or (ii) the sum of all the observed values (Total SUVmax/TLG), or (iii) each observed values (SUVmax/TLG-by-lesion). Standard RECIST response was assessed after 3 months of treatment. The association between metabolic and RECIST response was tested with the Mc Nemar’s test and their agreement was expressed as Kappa statistics; the ability to predict progression-free (PFS) and overall (OS) survival was tested with Log-rank test and a multivariable Cox model. Results: 33 patients were analyzed. After treatment, there was a notable decrease of all PET/CT parameters, with a median change of -33.9% for the highest SUVmax, -61.5% for the highest TLG, -34.9% for the total SUVmax, and -65.5% for the total TLG. The association of SUV-based metabolic response (but not the TLG-based) with RECIST was statistically significant. However, the agreement between RECIST and PET/CT responses was consistently small. PFS and OS were significantly longer among PET/CT responding patients, whichever the measure used. On the contrary, no significant outcome difference was evident according to RECIST response. Conclusions: Early PET/CT response was significantly predictive of long-term outcomes during preoperative treatment of patients with liver metastases from colorectal cancer and its predictive ability was higher than that of RECIST response. Clinical trial information: 2006-006572-38.

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Distant Liver Metastases as a Major Factor Influencing Survival in Patients with Colorectal Cancer

Folia Medica ◽

10.1515/folmed-2016-0023 ◽

2016 ◽

Vol 58 (3) ◽

pp. 182-187

Author(s):

Dimitar K. Penchev ◽

Lilyana V. Vladova ◽

Miroslav Z. Zashev ◽

Radosvet P. Gornev

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Median Survival ◽

Metastatic Disease ◽

Descriptive Analysis ◽

Distant Metastases ◽

University Hospital ◽

Rank Test ◽

Hepatic Metastatic Disease

Abstract Aim: To assess the effect of the factor ‘hepatic metastatic disease’ on long-term outcomes in patients with colorectal cancer. Materials and methods: We analysed retrospectively 200 randomly selected patients. Forty-two of them were excluded from the study for different reasons so the study contingent was 158 patients over a period of 23 years. All were diagnosed and treated in the Lozenetz University Hospital, in the Department of General Surgery. 125 of the patients were diagnosed with colorectal cancer without distant metastases and 33 of the patients had liver metastases as a result of colorectal carcinoma. The statistical analysis was performed using SPSS 19 IMB, with a level of significance of P < 0.05 at which the null hypothesis is rejected. We also used descriptive analysis, Kaplan-Meier estimator, Log-Rank Test and Life-Table statistics models. Results: The median survival for patients without metastases was 160 months, and the median was 102 months. The median survival for patients with liver metastases was 28 months and the median was 21 months. One-year survival for patients without metastases was 92% versus 69% in patients with liver metastases. Conclusion: Average, annual and median survivals are influenced statistically significantly by the presence of liver metastases compared to overall survival and that of patients without metastatic colorectal cancer. Liver metastatic disease is a proven factor affecting long-term prognosis and survival in patients with colorectal cancer.

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Positron Emission Tomography Combined With Computed Tomography vs. No Positron Emission Tomography Combined With Computed Tomography for the Management of Patients With Resectable Colorectal Cancer Liver Metastases and Synchronous Extrahepatic Disease

The American Surgeon ◽

10.1177/0003134820954834 ◽

2020 ◽

pp. 000313482095483

Author(s):

Pablo E. Serrano ◽

Chu-Shu Gu ◽

Carol-Anne Moulton ◽

Steven Gallinger

Keyword(s):

Colorectal Cancer ◽

Computed Tomography ◽

Positron Emission Tomography ◽

Liver Metastases ◽

Surgical Management ◽

Emission Tomography ◽

Colorectal Cancer Liver Metastases ◽

Positron Emission ◽

Pet Ct

Introduction Selected patients with colorectal cancer liver metastases (CRLM) and synchronous extrahepatic disease (EHD) are considered for surgery. Objectives To evaluate the change in surgical management and long-term survival (disease-free survival [DFS] and overall survival [OS]) for patients with CRLM and EHD who undergo positron emission tomography combined with computed tomography (PET-CT) vs no PET-CT. Methods Patients with CRLM were enrolled in a trial evaluating the effect of PET-CT (vs no PET-CT) on surgical management, DFS, and OS. This is a sub-study of the trial, including only patients with synchronous EHD. Cox proportional hazard models were used to calculate risks for recurrence and death. Survival were described by Kaplan-Meier method and compared with log-rank test. Results Of 25 patients with EHD (PET-CT arm: 14/270 (5%) and no PET-CT arm: 11/134 (8%)), PET-CT changed surgical management in 14%, all of which avoided liver resection due to more extensive disease. Complete metastasectomy was achieved in 36% (5/14) and 72% (8/11), respectively. Respectively, PET-CT vs no PET-CT had statistically similar median DFS, 5.6 months (95% confidence interval (CI) 3.6-18) vs 7.6 months (95% CI 2.9-15) and median OS, 42 months (95% CI 25-48) vs 29 months (95% CI 17-41). EHD was associated with worse DFS (hazard ratio HR = 1.89, 95% CI 1.41-2.52) and OS (HR = 2.47, 95% CI 1.6-3.83). Conclusions Preoperative PET-CT for the management of resectable CRLM did not improve long-term outcomes among patients who had synchronous EHD; however, it changed surgical management in a relatively significant proportion of patients.

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Determinants of short- and long-term outcome in patients undergoing simultaneous resection of colorectal cancer and synchronous colorectal liver metastases

International Journal of Colorectal Disease ◽

10.1007/s00384-011-1339-9 ◽

2011 ◽

Vol 27 (3) ◽

pp. 363-369 ◽

Cited By ~ 12

Author(s):

C. S. D. Roxburgh ◽

C. H. Richards ◽

S. J. Moug ◽

A. K. Foulis ◽

D. C. McMillan ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Term Outcome ◽

Long Term Outcome ◽

Simultaneous Resection ◽

Synchronous Colorectal Liver Metastases ◽

Short And Long Term

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Abstract 40: Should Bilateral Internal Thoracic Artery Grafting Be Used in Emergency Patients?

Circulation ◽

10.1161/circ.130.suppl_2.40 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Yanai Ben-Gal ◽

Rephael Mohr ◽

Dimitri Pevni ◽

Amir Ganiel ◽

Amir Kramer ◽

...

Keyword(s):

Internal Thoracic Artery ◽

Cox Model ◽

Rank Test ◽

Term Outcome ◽

Long Term Outcome ◽

Emergency Patients ◽

Kaplan Meier ◽

Increased Risk ◽

Bilateral Internal Thoracic Artery

HYPOTHESIS: Bilateral Internal Thoracic Artery (BITA) grafting is not often used in emergency coronary artery bypass grafting (CABG) due to questionable survival benefit ,relative complexity and increased risk of sternal infection compared to operations incorporating Single Internal Thoracic Artery (SITA). The purpose of this study is to compare early and long term outcome of emergent patients undergoing BITA grafting, to that of emergent patients undergoing CABG with SITA METHODS: Four hundred thirty eight emergency patients underwent BITA grafting between 1996 and 2008. They were compared with 339 emergency patients who underwent CABG with SITA RESULTS: Occurrence of female gender (18.5% vs. 29.5%, P< 0.001, in the BITA and SITA groups, respectively), diabetes (25.3% vs. 38.6%, P< 0.001), age 70+ (61.0% vs.39.7%, P< 0.001), chronic obstructive pulmonary disease (5.7% vs.13.9%, P< 0.001) EF <30% (12.1% vs. 17.1%, P< 0.001), and chronic renal failure (7.1% vs. 17.1%, p< 0.001) was lower in the BITA group. On the other hand critical preoperative state (35.4% vs. 26.0%, P= 0.003), and recent myocardial infarction (39.5% vs. 32.7%, P= 0.031) were more prevalent among BITA patients. Euro score I of SITA patients was significantly higher (10.58 ± 4.1 vs.8.65 ± 3.5, P= 0.016). Operative mortality (5.3% vs 7.4%, BITA vs. SITA), and sternal wound infections (2.7% vs. 2.1%) were not significantly different between groups. Mean follow-up was 8.75 ± 4.75 years. Ten year survival (Kaplan-Meier) of SITA patients with euro score 11+ was similar to that of BITA patients with euro score 11+. (34% vs. 37%, log rank test) .However, Kaplan-Meier 10 year survival of BITA patients with euro score I of 10 or lower was significantly better(80% vs. 68%, , BITA and SITA groups, respectively , P= 0.012 ).Assignment to the BITA group in the subset with lower euro score was also associated with better propensity adjusted survival ( HR 4.8 p < 0.001, compared to the SITA group, COX model) CONCLUSIONS: This large cohort study shows that,BITA grafting may be used in emergency patients., In medium and low risk emergency patients long term outcome is better than that of patients treated with SITA

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Effect of PET-CT on disease recurrence and its management in patients with potentially resectable colorectal cancer liver metastases: The long-term results of a randomized control trial.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.562 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 562-562

Author(s):

Pablo Emilio Serrano Aybar ◽

Chu-Shu Gu ◽

Mohamed Husien ◽

Diederick Jalink ◽

Guillaume Martel ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Surgical Management ◽

Disease Recurrence ◽

Long Term Results ◽

Colorectal Cancer Liver Metastases ◽

Pet Ct ◽

Risks Factors

562 Background: The PETCAM randomized trial evaluated the effect of preoperative PET-CT (vs. no PET-CT) on surgical management in patients with colorectal cancer liver metastases. In this study, 8% of patients had a change in surgical management, including a higher proportion of major liver resections in the PET-CT arm. The current study compares the intervention groups for 5-year disease free (DFS) and overall survival (OS), and evaluated their long-term clinical course, i.e. sites of recurrence and management of disease recurrence. Methods: Recruitment to the trial occurred between 2005-2010, with last follow-up in 2013. Data on recurrence, management of recurrence and mortality from 2013-2017 was collected from patient’s charts. Recurrences according to site and management were described. Cox proportional Hazard Models were used to calculate the risk for recurrence and death. OS was calculated with Kaplan-Meir method and compared with log-rank test. Results: At 5 years, 157 of 404 (39%) patients were still alive and 19 patients were lost to follow-up. Median follow-up is 4.2 years. There were no differences in DFS (HR: 1.12, 95%CI: 0.88-1.42) or OS (HR: 0.97, 95%CI: 0.74-1.28) between groups. The median DFS for the 372 patients who had surgery was 17 months, 95%CI: 14.7-19.4. Risks factors for recurrence were: extrahepatic disease, liver tumour size, and nodal stage. The median OS for all patients was 50 months, 95%CI: 43.5-64.3. Risks factors for death also included age and prior use of chemotherapy. During the follow-up period, 287/404, 71% patients recurred (mostly liver and lung); 137 (48%) were treated solely with chemotherapy and 35% were treated with surgery with curative intent. Of these, the majority recurred (109/116, 94%). The median OS following first recurrence was 27.5 months, 95%CI: 23-30. Conclusions: PET-CT did not improve DFS or OS. Survival following liver resection is similar to previous reports, however most patients experience disease recurrence. A substantial proportion of patients who recur undergo surgery, however it is likely that they will recur again.

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