Role of adjuvant therapy in colorectal cancer reviewed

In colorectal cancer (CRC), 20–50% of patients relapse after curative-intent surgery with or without adjuvant therapy. We investigated the lead times and prognostic value of post-adjuvant (8 months from randomisation to adjuvant treatment) serum CEA, CA19-9, IL-6, CRP, and YKL-40. We included 147 radically resected stage II–IV CRC treated with 24 weeks of adjuvant 5-fluorouracil-based chemotherapy in the phase III LIPSYT-study (ISRCTN98405441). All 147 were included in lead time analysis, but 12 relapsing during adjuvant therapy were excluded from post-adjuvant analysis. Elevated post-adjuvant CEA, IL-6, and CRP were associated with impaired disease-free survival (DFS) with hazard ratio (HR) 5.21 (95% confidence interval 2.32–11.69); 3.72 (1.99–6.95); 2.58 (1.18–5.61), respectively, and elevated IL-6 and CRP with impaired overall survival (OS) HR 3.06 (1.64–5.73); 3.41 (1.55–7.49), respectively. Elevated post-adjuvant IL-6 in CEA-normal patients identified a subgroup with impaired DFS. HR 3.12 (1.38–7.04) and OS, HR 3.20 (1.39–7.37). The lead times between the elevated biomarker and radiological relapse were 7.8 months for CEA and 10.0–53.1 months for CA19-9, IL-6, CRP, and YKL-40, and the lead time for the five combined was 27.3 months. Elevated post-adjuvant CEA, IL-6, and CRP were associated with impaired DFS. The lead time was shortest for CEA.

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Potential Role of KRAS and Other Mutations in the Adjuvant Therapy of Colorectal Cancer

Current Colorectal Cancer Reports ◽

10.1007/s11888-012-0133-6 ◽

2012 ◽

Vol 8 (3) ◽

pp. 192-203

Author(s):

Gilles Manceau ◽

Pierre Laurent-Puig

Keyword(s):

Colorectal Cancer ◽

Adjuvant Therapy ◽

Potential Role

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The role of chemotherapy and adjuvant therapy in the management of colorectal cancer

Cancer ◽

10.1002/1097-0142(19941001)74:7+<2151::aid-cncr2820741724>3.0.co;2-s ◽

1994 ◽

Vol 74 (S7) ◽

pp. 2151-2153 ◽

Cited By ~ 17

Author(s):

Walter B. Forman

Keyword(s):

Colorectal Cancer ◽

Adjuvant Therapy

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The Change of Systemic Immune-Inflammation Index Independently Predicts Survival of Colorectal Cancer Patients after Curative Resection

Mediators of Inflammation ◽

10.1155/2020/4105809 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Qingqing Chen ◽

Haohao Wu ◽

Xinwei Guo ◽

Ke Gu ◽

Wenjie Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Adjuvant Therapy ◽

Vascular Invasion ◽

Curative Resection ◽

Cox Regression ◽

Univariate Analysis ◽

Disease Free Survival ◽

Immune Inflammation ◽

Pathological Stages

Background. The systemic immune-inflammation index (SII) has an important role in predicting survival in some solid tumors. However, little information is available concerning the change of the SII (∆SII) in colorectal cancer (CRC) after curative resection. This study was designed to evaluate the role of ∆SII in CRC patients who received surgery. Methods. A total 206 patients were enrolled in this study. Clinicopathologic characteristics and survival were assessed. The relationships between overall survival (OS), disease-free survival (DFS), and ∆SII were analyzed with both univariate Kaplan-Meier and multivariate Cox regression methods. Results. Based on the patient data, the receiver operating characteristic (ROC) optimal cutoff value of ∆SII was 127.7 for OS prediction. The 3-year and 5-year OS rates, respectively, were 60.4% and 36.7% in the high-∆SII group (>127.7) and 87.6% and 79.8% in the low-∆SII group (≤127.7). The 3-year and 5-year DFS rates, respectively, were 54.1% and 34.1% in the high-∆SII group and 80.3% and 78.5% in the low-∆SII group. In the univariate analysis, smoking, pathological stages III-IV, high-middle degree of differentiation, lymphatic invasion, vascular invasion, and the high-ΔSII group were associated with poor OS. Adjuvant therapy, pathological stages III-IV, vascular invasion, and ΔSII were able to predict DFS. Multivariate analysis revealed that pathological stages III-IV ( HR = 0.442 , 95% CI = 0.236 -0.827, p = 0.011 ), vascular invasion ( HR = 2.182 , 95% CI = 1.243 -3.829, p = 0.007 ), and the high-ΔSII group ( HR = 4.301 , 95% CI = 2.517 -7.350, p < 0.001 ) were independent predictors for OS. Adjuvant therapy ( HR = 0.415 , 95% CI = 0.250 -0.687, p = 0.001 ), vascular invasion ( HR = 3.305 , 95% CI = 1.944 -5.620, p < 0.001 ), and the high-ΔSII group ( HR = 4.924 , 95% CI = 2.992 -8.102, p < 0.001 ) were significant prognostic factors for DFS. Conclusions. The present study demonstrated that ∆SII was associated with the clinical outcome in CRC patients undergoing curative resection, supporting the role of ∆SII as a prognostic biomarker.

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The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

Digestive Disease Interventions ◽

10.1055/s-0040-1715816 ◽

2020 ◽

Vol 04 (03) ◽

pp. 291-302

Author(s):

Mariam F. Eskander ◽

Christopher T. Aquina ◽

Aslam Ejaz ◽

Timothy M. Pawlik

Keyword(s):

Colorectal Cancer ◽

Portal Vein ◽

Surgical Oncology ◽

Portal Vein Ligation ◽

Safe Alternative ◽

Colorectal Cancer Liver Metastases ◽

Liver Remnant ◽

New Era ◽

Ablation Therapy

AbstractAdvances in the field of surgical oncology have turned metastatic colorectal cancer of the liver from a lethal disease to a chronic disease and have ushered in a new era of multimodal therapy for this challenging illness. A better understanding of tumor behavior and more effective systemic therapy have led to the increased use of neoadjuvant therapy. Surgical resection remains the gold standard for treatment but without the size, distribution, and margin restrictions of the past. Lesions are considered resectable if they can safely be removed with tumor-free margins and a sufficient liver remnant. Minimally invasive liver resections are a safe alternative to open surgery and may offer some advantages. Techniques such as portal vein embolization, association of liver partition with portal vein ligation for staged hepatectomy, and radioembolization can be used to grow the liver remnant and allow for resection. If resection is not possible, nonresectional ablation therapy, including radiofrequency and microwave ablation, can be performed alone or in conjunction with resection. This article presents the most up-to-date literature on resection and ablation, with a discussion of current controversies and future directions.

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