Prognostic factors in patients who received surgery for colorectal cancer with peritoneal metastasis.

574 Background: Peritoneal metastasis (PM) in patients diagnosed with colon cancer is associated with a poor prognosis. We aimed to analyze prognostic factors associated with PM in patients diagnosed with colorectal cancer (CRC). Methods: We evaluated 237 patients who underwent surgery between 2002 and 2016 for CRC with PM. The extent of PM was evaluated using the Peritoneal Cancer Index (PCI). Clinicopathological variables, PCI score, surgical curability, and the administration of postoperative chemotherapy were evaluated. Overall survival was analyzed using the Kaplan-Meier method. Multivariate analysis was performed to assess the prognostic value of these variables, using the Cox regression model. Results: Our patients included 119 men and 118 women with a median age of 64 (range: 21–90) years. The primary tumor sites were the right-sided colon (n = 103), left-sided colon (n = 84), and rectum (n = 50). The median PCI score was 4 (range: 1–30). Synchronous PM was detected at the time of diagnosis of the primary tumor in 165 patients (69.6%). Distant metastases except peritoneal metastases was detected in 137 patients (57.8%). R0 resection was performed in 62 patients (19.0%). Postoperative chemotherapy was performed in 165 patients (69.6%). The median survival time in all patients was 19.4 (range: 0–30) months, and the five-year overall survival rate was 16.3%. Multivariate analysis revealed that PCI ≤ 5 (hazard ratio [HR]: 2.56, 95% confidence interval [CI]: 1.56-4.32, P < 0.01); the absence of distant metastasis, except peritoneal metastasis (HR: 1.65, CI: 1.15-2.40, P < 0.01); R0 resection (HR: 4.21, CI: 2.44-7.50, P < 0.01) affected the survival rate. Conclusions: Our results show that a low PCI, the absence of distant metastasis except peritoneal metastasis, and R0 resection are prognostic factors in patients diagnosed with PM-CRC.

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The Clinical and Prognostic Significance of Protein Arginine Deiminases 2 and 4 in Colorectal Cancer

Pathobiology ◽

10.1159/000518414 ◽

2021 ◽

pp. 1-11

Author(s):

Mohamed Gijon ◽

Rachael L. Metheringham ◽

Michael S. Toss ◽

Samantha J. Paston ◽

Lindy G. Durrant

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Survival Time ◽

Patient Survival ◽

Prognostic Significance ◽

High Expression ◽

Related Protein ◽

Post Translational Modification

Introduction: Protein arginine deiminases (PADIs) are a family of enzymes that catalyse the post-translational modification of proteins. Association between PADI expression and clinicopathology, protein expression, and outcome was determined. Methods: PADI2 and PADI4 expression was assessed immunohistochemically in a cohort of colorectal cancer (CRC) patients. Results: CRC tissues expressed variable levels of PADI2 which was mainly localised in the cytoplasm and correlated with patient survival (p = 0.005); high expression increased survival time from 43.5 to 67.6 months. Expression of cytoplasmic PADI2 correlated with the expression of nuclear β catenin, PADI4, and alpha-enolase. In contrast, expression of nuclear PADI2 correlated with a decrease in survival (p = 0.010), with high expression decreasing survival from 76.4 to 42.9 months. CRC tissues expressed variable levels of PADI4 in both the nucleus and cytoplasm. Expression of cytoplasmic PADI4 correlated with survival (p = 0.001) with high expression increasing survival time from 48.1 to 71.8 months. Expression of cytoplasmic PADI4 correlated with expression of nuclear β catenin, alpha-enolase (p ≤ 0.0001, p = 0.002), and the apoptotic related protein, Bcl-2. Expression of nuclear PADI4 also correlated with survival (p = 0.011), with high expression of nuclear PADI4 increasing survival time from 55.4 to 74 months. Expression of nuclear PADI4 correlated with p53, alpha-enolase, and Bcl-2. Multivariate analysis showed that TNM stage, cytoplasmic PADI2, and PADI4 remained independent prognostic factors in CRC. Both PADI2 and PADI4 are good prognostic factors in CRC. Conclusion: High expression of cytoplasmic PADI2, PADI4, and nuclear PADI4 were associated with an increase in overall survival.

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Metastatic colorectal cancer: What about the primary?

Acta chirurgica iugoslavica ◽

10.2298/aci1202047p ◽

2012 ◽

Vol 59 (2) ◽

pp. 47-55

Author(s):

Irinel Popescu ◽

Tiberiu Alexandrescu

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Survival Rate ◽

Liver Metastases ◽

Safety Profile ◽

Primary Tumor ◽

Survival Rates ◽

Therapeutic Strategies ◽

Unresectable Liver Metastases ◽

Synchronous Metastases

Background: Approximately 25% of patients with colorectal cancer present synchronous metastases, most frequently located in the liver. Aims: The assessment of optimal therapeutic strategies for the primary tumor in such patients. Methods: We analyzed the outcomes of 209 patients who underwent simultaneous or delayed resection of the primary tumor and liver metastases, the survival rates of patients with initially unresectable liver metastases that were rendered resectable, and the prognostic factors related to the primary tumor. Results: The outcomes of simultaneous resections were similar to those of delayed resection. In patients with initially unresectable liver metastases that were rendered resectable, the survival rates were similar to those of patients with initially resectable metastases. The survival rate of N2 patients was significantly lower than those of N1 and N0 patients. Conclusions: Simultaneous resection provides a safety profile and survival rate similar to that of delayed resection. The N category allows for prognostic estimation in metastatic colorectal patients.

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Outcome of patients with colorectal cancer undergoing lung metastases resection: a single-institution retrospective analysis

Tumori Journal ◽

10.1177/0300891620930793 ◽

2020 ◽

pp. 030089162093079

Author(s):

Marco Mammana ◽

Francesca Bergamo ◽

Letizia Procaccio ◽

Marco Schiavon ◽

Fotios Loupakis ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Cox Regression ◽

Multivariable Analysis ◽

Postoperative Chemotherapy ◽

Single Institution ◽

Relapse Free Survival ◽

Free Survival ◽

Lung Metastasectomy

Introduction: This study was undertaken to review a single-institution cohort of patients with metastatic colorectal cancer undergoing lung resection after a multidisciplinary evaluation and to investigate the main prognostic factors for survival. Methods: Medical records of 129 patients undergoing lung metastasectomy for colorectal cancer with curative intent from 2001 to 2017 were reviewed. Tissue samples from the primary tumor were analyzed with a multiplex genotyping system for the detection of mutations in RAS and BRAF genes. Survival analyses were carried out by the Kaplan-Meier method. Univariate and multivariable analyses were performed using the log-rank test and the Cox regression model. Results: Postoperative morbidity and mortality were 13.2% and 0%, respectively. At a median follow-up time of 62.5 months, median overall survival was 90.5 months and median relapse-free survival was 42.8 months. Multivariable analysis for overall survival identified synchronous versus metachronous metastatic presentation as the only prognostic factor, whereas relapse-free survival was independently associated with synchronous versus metachronous metastatic presentation, number of metastases, and postoperative chemotherapy. Conclusions: This study shows particularly favorable survival outcomes for patients undergoing lung metastasectomy. The validity of some of the main prognostic factors was confirmed and a positive effect of postoperative chemotherapy on relapse-free survival was shown. Contrary to other reports, the presence of KRAS mutations was not associated with significant survival differences. Further studies are needed in order to clarify the interactions between molecular, clinical, and pathologic characteristics and treatment-related factors.

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Univariate and Multivariate Analysis of Prognostic Factors in the Surgical Treatment of Hilar Cholangiocarcinoma

The American Surgeon ◽

10.1177/000313481007601129 ◽

2010 ◽

Vol 76 (11) ◽

pp. 1260-1268 ◽

Cited By ~ 10

Author(s):

Giovanni Ramacciato ◽

Giuseppe Nigri ◽

Riccardo Bellagamba ◽

Niccolò Petrucciani ◽

Matteo Ravaioli ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Hilar Cholangiocarcinoma ◽

R0 Resection ◽

Safe Procedure ◽

Tumor Grading ◽

Curative Intent ◽

Aggressive Surgical Approach ◽

Well Differentiated

Surgery is the only effective treatment able to improve survival of patients with hilar cholangiocarcinoma (CCA). However, the significance of prognostic factors on overall survival is still debated. We evaluated early and long-term outcomes of patients resected for hilar cholangiocarcinoma over a 3-year period to determine the role of prognostic factors and their effect on overall survival. Medical records of patients with hilar CCA who underwent resection between January 2001 and December 2004 were retrospectively reviewed. Univariate and multivariate analysis was performed to identify prognostic factors associated with survival. Thirty-two of 45 patients underwent surgical resection with curative intent. Morbidity was 24.4 per cent; perioperative mortality was 0 per cent. Overall median survival was 22.3 months. Well-differentiated tumor grading and R0 resection were independently associated with better survival at multivariate analysis. Aggressive surgery, including biliary resection combined with major hepatectomy, is a safe procedure with low morbidity and mortality in a tertiary referral hepatobiliary center. The main aim of an aggressive surgical approach is to obtain a microscopic margin-negative resection, which is associated with better prognosis. Another important prognostic factor is tumor grading, which is independently associated with survival.

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Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.22.4949 ◽

2009 ◽

Vol 27 (31) ◽

pp. 5131-5137 ◽

Cited By ~ 233

Author(s):

Catherine Liebig ◽

Gustavo Ayala ◽

Jonathan Wilks ◽

Gordana Verstovsek ◽

Hao Liu ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Multivariate Analysis ◽

Survival Rate ◽

Perineural Invasion ◽

Disease Free Survival ◽

Free Survival ◽

Node Negative ◽

Disease Free Survival Rate ◽

Disease Free

Purpose Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients. Patients and Methods We identified 269 consecutive patients who had CRC resected at our institution. Tumors were rereviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test. Results PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P < .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival. Conclusion PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment.

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Nomogram for predicting overall survival in colorectal cancer with distant metastasis

BMC Gastroenterology ◽

10.1186/s12876-021-01692-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zheng Liu ◽

Yao Xu ◽

Guijun Xu ◽

Vladimir P. Baklaushev ◽

Vladimir P. Chekhonin ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Cancer Patients ◽

Distant Metastasis ◽

Primary Tumour ◽

Stage Iv ◽

Cox Proportional Hazards ◽

Stage Iv Colorectal Cancer ◽

Colorectal Cancer Patients

Abstract Background Colorectal cancer (CRC) is a major cancer burden, and prognosis is determined by many demographic and clinicopathologic factors. The present study aimed to construct a prognostic nomogram for colorectal cancer patients with distant metastasis. Methods Colorectal cancer patients with distant metastasis diagnosed between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results database. Cox proportional hazards regression was used to identify independent prognostic factors. A nomogram was constructed to predict survival, and validation was performed. Results A total of 7099 stage IV colorectal cancer patients were enrolled in the construction cohort. The median overall survival was 20.0 (95% CI 19.3–20.7) months. Age at diagnosis, marital status, race, primary tumour site, tumour grade, CEA level, T stage, N stage, presence of bone, brain, liver and lung metastasis, surgery for primary site and performance of chemotherapy were independent prognostic factors. The nomogram was constructed and the calibration curve showed satisfactory agreement. The C-index was 0.742 (95% CI 0.726–0.758). In the validation cohort (7098 patients), the nomogram showed satisfactory discrimination and calibration with a C-index of 0.746 (95% CI 0.730–0.762). Conclusion A series of factors associated with the survival of CRC patients with distant metastasis were found. Based on the identified factors, a nomogram was generated to predict the survival of stage IV colorectal cancer patients. The predictive model showed satisfactory discrimination and calibration, which can provide a reference for survival estimation and individualized treatment decisions.

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Prognostic Factors of Radiofrequency Ablation plus Systemic Chemotherapy for Unresectable Colorectal Cancer with Liver Metastasis

International Journal of Hepatology ◽

10.1155/2020/8836922 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Ky Thai Doan ◽

Long Nguyễn Việt ◽

Thinh Nguyen Tien ◽

Binh Nguyen Canh ◽

Hoai Ngo Thi ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Radiofrequency Ablation ◽

Liver Metastasis ◽

Systemic Chemotherapy ◽

Univariate Analysis ◽

Survival Rates ◽

Liver Lesions

Introduction. Survival outcomes in patients with unresectable colorectal cancer (CRC) liver metastasis treated by radiofrequency ablation (RFA) combined with systemic chemotherapy and correlation with potential prognostic factors were investigated. Material and Methods. A retrospective cohort study was conducted on 61 CRC patients with unresectable liver metastasis who underwent liver tumor-directed percutaneous RFA combined with conventional systemic chemotherapy between October 2013 and September 2018. Survival analyses were conducted using the Kaplan-Meier method, and the log-rank test was used to characterize differences in the median survival time and the 1-year, 3-year, and 5-year overall survival rates of subgroups to identify prognostic factors. Results. Median overall survival and progression-free survival of all patients were 32 and 14 months, respectively. The cumulative survival rates at 1-, 3-, and 5-years were 93.2%; 44.5%, and 38.2%, respectively. Univariate analysis revealed that pre-RFA serum CEA levels, Eastern Cooperative Oncology Group (ECOG) status, number of liver lesions, the size of the largest lesion, and the total lesion size were prognostic factors. However, multivariate analysis demonstrated that only the number of liver lesions and the size of the largest lesion were independent prognostic factors for survival. Conclusion. RFA plus systemic chemotherapy provides an encouraging survival outcome for patients with unresectable CRC liver metastasis. Multivariate analysis demonstrated that the number and size of liver metastatic lesions are independent prognostic factors for survival.

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Carbon Ion Radiotherapy for Oligo-Recurrence in the Lung

Pulmonary Medicine ◽

10.1155/2013/219746 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Naoyoshi Yamamoto ◽

Mio Nakajima ◽

Hirohiko Tsujii ◽

Tadashi Kamada

Keyword(s):

Colorectal Cancer ◽

Lung Cancer ◽

Overall Survival ◽

Survival Rate ◽

Local Control ◽

Local Control Rate ◽

Carbon Ion Radiotherapy ◽

Overall Survival Rate ◽

Carbon Ion ◽

Metastatic Lung

The clinical results after carbon ion radiotherapy for the metastatic lung tumors believed to be in the state of oligo-recurrence were evaluated. One hundred and sixteen lesions in 91 patients with lung cancer metastasis were treated with carbon ion radiotherapy at our institute from April 1997 to February 2011. Regarding the prescribed dose, total dose ranged between 40 gray equivalents (GyE) and 80 GyE, and fraction size ranged from 1 to 16 fractions. After a median followup period of 2.3 years (range, 0.3–13.1 years), the statistical overall survival rate and local control rate were 71.2% and 91.9% at 2 years after treatment, respectively. Treatment-related side effects were not a clinical problem. When classified by the primary organ, there were 49 cases of lung cancer, 20 cases of colorectal cancer, and 22 cases of others. The overall survival rate and local control rate for lung metastasis cases from lung cancer at 2 years after treatment were 81.5% and 92.4%, respectively, and 65.0% and 92.0% regarding lung metastasis from colorectal cancer. Carbon ion beam therapy for the metastatic lung tumors is a safe therapy, and the therapeutic effect is comparable to the outcome obtained from reported surgical resections.

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