scholarly journals Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 900
Author(s):  
Sophie Müller ◽  
Franziska Köhler ◽  
Anne Hendricks ◽  
Carolin Kastner ◽  
Kevin Börner ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Brain Metastases ◽  
Lung Metastases ◽  
Meta Analysis ◽  
Blood Levels ◽  
Kras Mutations ◽  
Therapy Regimen ◽  
Multiple Metastases

Colorectal cancer (CRC) is the third most common malignancy worldwide. Most patients with metastatic CRC develop liver or lung metastases, while a minority suffer from brain metastases. There is little information available regarding the presentation, treatment, and overall survival of brain metastases (BM) from CRC. This systematic review and meta-analysis includes data collected from three major databases (PubMed, Cochrane, and Embase) based on the key words “brain”, “metastas*”, “tumor”, “colorectal”, “cancer”, and “malignancy”. In total, 1318 articles were identified in the search and 86 studies matched the inclusion criteria. The incidence of BM varied between 0.1% and 11.5%. Most patients developed metastases at other sites prior to developing BM. Lung metastases and KRAS mutations were described as risk factors for additional BM. Patients with BM suffered from various symptoms, but up to 96.8% of BM patients were asymptomatic at the time of BM diagnosis. Median survival time ranged from 2 to 9.6 months, and overall survival (OS) increased up to 41.1 months in patients on a multimodal therapy regimen. Several factors including age, blood levels of carcinoembryonic antigen (CEA), multiple metastases sites, number of brain lesions, and presence of the KRAS mutation were predictors of OS. For BM diagnosis, MRI was considered to be state of the art. Treatment consisted of a combination of surgery, radiation, or systemic treatment.

scholarly journals Long-Survivors with Lung Metastases and Kras Mutations Have an Increased Risk to Develop Brain Metastases From Colorectal Cancer

2013 ◽  
Vol 24 ◽  
pp. iv15
Author(s):  
Federica Zoratto ◽  
Fotios Loupakis ◽  
Chiara Cremolini ◽  
Lisa Salvatore ◽  
Marta Schirripa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Brain Metastases ◽  
Lung Metastases ◽  
Kras Mutations ◽  
Increased Risk

Association Between Vitamin D and Risk of Colorectal Cancer: A Systematic Review of Prospective Studies

2011 ◽  
Vol 29 (28) ◽  
pp. 3775-3782 ◽  
Author(s):  
Yanlei Ma ◽  
Peng Zhang ◽  
Feng Wang ◽  
Jianjun Yang ◽  
Zhihua Liu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Rectal Cancer ◽  
Vitamin D ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Blood Levels ◽  
Hydroxyvitamin D ◽  
Vitamin D Intake ◽  
25 Hydroxyvitamin D

Purpose To conduct a systematic review of prospective studies assessing the association of vitamin D intake or blood levels of 25-hydroxyvitamin D [25(OH)D] with the risk of colorectal cancer using meta-analysis. Methods Relevant studies were identified by a search of MEDLINE and EMBASE databases before October 2010 with no restrictions. We included prospective studies that reported relative risk (RR) estimates with 95% CIs for the association between vitamin D intake or blood 25(OH)D levels and the risk of colorectal, colon, or rectal cancer. Approximately 1,000,000 participants from several countries were included in this analysis. Results Nine studies on vitamin D intake and nine studies on blood 25(OH)D levels were included in the meta-analysis. The pooled RRs of colorectal cancer for the highest versus lowest categories of vitamin D intake and blood 25(OH)D levels were 0.88 (95% CI, 0.80 to 0.96) and 0.67 (95% CI, 0.54 to 0.80), respectively. There was no heterogeneity among studies of vitamin D intake (P = .19) or among studies of blood 25(OH)D levels (P = .96). A 10 ng/mL increment in blood 25(OH)D level conferred an RR of 0.74 (95% CI, 0.63 to 0.89). Conclusion Vitamin D intake and blood 25(OH)D levels were inversely associated with the risk of colorectal cancer in this meta-analysis.

scholarly journals Effect of starting dose of regorafenib on overall survival of patients with metastatic colorectal cancer: a systematic review and meta-analysis

2019 ◽  
Vol 21 (3) ◽  
pp. 10-15
Author(s):  
Mikhail Yu Fedyanin ◽  
Elizaveta M Polyanskaya ◽  
Alexey A Tryakin ◽  
Ilia A Pokataev ◽  
Sergei A Tjulandin
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Clinical Practice ◽  
Metastatic Colorectal Cancer ◽  
Meta Analysis ◽  
Research Data ◽  
Routine Clinical Practice ◽  
Starting Dose ◽  
Review Manager

Aim. To conduct a systematic review and meta-analysis of studies on the effect of starting dose of regorafenib on overall survival (OS) of patients with chemorefractory metastatic colorectal cancer. Materials and methods. We searched for research data in the PubMed. The analysis included all publications till 08.20.2019 which compared OS depending on the starting dose of regorafenib (160 mg or less) in the 1st course of therapy. Meta-analysis was conducted using Review Manager Ver. 5.3. Results. Two studies demonstrated decreased OS at starting dose of less than 160 mg (A. Adenis et al., 2016: risk ratio - RR 1.26, 95% confidence interval - CI 1.01-1.56; A. Aljubran et al., 2019: RR 2.25, 95% CI 0.93-5.43). Two studies showed an improvement in OS with a starting dose of less than 160 mg in the 1st course (T. Bekaii-Saab et al., 2018: RR 0.72, 95% CI 0.47-1,11; J. Gotfrit et al., 2017: RR 0.46, 95% CI 0.17-1.22). In two other studies, there was no effect of a starting dose of regorafenib on OS (K. Yamaguchi et al., 2019: RR 0.95, 95% CI 0.82-1.1; G. Argiles et al., 2019: RR 0,86, 95% CI 0.65-1.13). The meta-analysis did not reveal the effect of starting dose of the drug on OS: RR 0.97, 95% CI 0.78-1.21; p=0.79; I2=64. Conclusions. Reducing the starting dose of regorafenib in the 1st course does not decrease OS and can be recommended for routine clinical practice.

scholarly journals Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Michael G. Fadel ◽  
George Malietzis ◽  
Vasilis Constantinides ◽  
Gianluca Pellino ◽  
Paris Tekkis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Meta Analysis ◽  
Mucinous Carcinoma ◽  
Signet Ring Cell ◽  
Cochrane Library ◽  
Survival Outcomes ◽  
Signet Ring ◽  
Ring Cell

Abstract Background Histological subtypes of colorectal cancer may be associated with varied prognostic features. This systematic review and meta-analysis aimed to compare clinicopathological characteristics, recurrence and overall survival between colorectal signet-ring cell (SC) and mucinous carcinoma (MC) to conventional adenocarcinoma (AC). Methods A literature search of MEDLINE, EMBASE, Ovid and Cochrane Library was performed for studies that reported data on clinicopathological and survival outcomes on SC and/or MC versus AC from January 1985 to May 2020. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. Results Thirty studies of 1,087,055 patients were included: 11,510 (1.06%) with SC, 110,179 (10.13%) with MC and 965,366 (88.81%) with AC. Patients with SC were younger than patients with AC (WMD − 0.47; 95% CI − 0.84 to –0.10; I2 88.6%; p = 0.014) and more likely to have right-sided disease (OR 2.12; 95% CI 1.72–2.60; I2 82.9%; p < 0.001). Locoregional recurrence at 5 years was more frequent in patients with SC (OR 2.81; 95% CI 1.40–5.65; I2 0.0%; p = 0.004) and MC (OR 1.92; 95% CI 1.18–3.15; I2 74.0%; p = 0.009). 5-year overall survival was significantly reduced when comparing SC and MC to AC (HR 2.54; 95% CI 1.98–3.27; I2 99.1%; p < 0.001 and HR 1.38; 95% CI 1.19–1.61; I2 98.6%; p < 0.001, respectively). Conclusion SC and MC are associated with right-sided lesions, advanced stage at presentation, higher rates of recurrence and poorer overall survival. This has strong implications towards surgical and oncological management and surveillance of colorectal cancer.

scholarly journals SP1.2.13Prediction of malignant progression of colorectal adenomatous polyps – A complete systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Kiran Altaf ◽  
Sukhpreet Gahunia ◽  
Sarah Zhao ◽  
Shakil Ahmed
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
P53 Mutation ◽  
Malignant Progression ◽  
Colorectal Adenomas ◽  
Cochrane Library ◽  
Kras Mutations ◽  
Surveillance Programme ◽  
Meta Analyses

Abstract Aims Only 5% of colorectal adenomas (CA) progress to cancer. Identifying these is highly relevant for colorectal cancer screening risk. Currently, no biomarkers exist that predict this malignant progression. We looked at the effectiveness of common genetic aberrations as potential biomarkers through systematic review and meta-analyses. Methods MEDLINE, EMBASE and Cochrane Library were searched to identify all studies that assessed p53, APC, p21, BRAF, MLH1, MSH2, CIMP and Kras mutations as prognostic markers in CA. Main outcome measure was the development of colorectal cancer. Results 109 clinical studies were included. P53 mutation [DOR 8.37 (5.21-13.42), sensitivity 55% (52-58%), specificity 85% (83-87%), PLR 4.23 (2.60-6.88), NLR 0.57 (0.57-0.64), AUC 0.7532] was found to be superior to all other mutations. Mutations of APC [DOR 0.57 (0.16-2.01), sensitivity 19% (4-25%), specificity 71% (66-76%), PLR 0.71 (0.33-1.54), NLR 1.19 (0.84-1.69)], BRAF [DOR 0.38 (0.22-0.67), sensitivity 12% (11-14%), specificity 60% (58-62%), PLR 0.57 (0.38-0.84), NLR 1.27 (1.12-1.44)], Kras [DOR 1.22 (0.72-2.0), sensitivity 33% (30-37%), specificity 74% (71-76%), PLR 1.17 (0.81-1.68), NLR 0.94 (0.83-1.07)], MLH1 [DOR 2.48 (1.05-5.84), sensitivity 26% (23-30%), specificity 82% (79-84%), PLR 1.74 (0.95-3.19)], MSH2 [DOR 1.06 (0.53-2.13), sensitivity 22% (17-27%), specificity 88% (84-90%), PLR 1.03 (0.62-1.70), NLR 0.99 (0.91-1.07)] and CIMP [DOR 1.88 (0.25-13.88), sensitivity 30% (23-36%), specificity 76% (72-80%), PLR 1.31 (0.29-5.99), NLR 0.76 (0.40-1.45)] failed to demonstrate any advantage over p53. Conclusions p53 mutations effectively predict malignant progression in CA. Panel of biomarkers would be more suited for surveillance programme. This needs confirmation in prospective clinical trials with cost-efficiency analyses.

Oral fluoropyrimidines versus 5-fluorouracil for colorectal cancer: Results of a systematic review and meta-analysis

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4111-4111
Author(s):  
A. D. Sasse ◽  
E. C. Sasse ◽  
L. V. dos Santos ◽  
J. S. Lima ◽  
C. M. Nascente ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Progression Free Survival ◽  
Fixed Effect Model ◽  
Free Survival ◽  
Oral Fluoropyrimidines ◽  
First Choice

4111 Background: Previous studies showed that continuous intravenous infusion (cIV) of 5-fluorouracil (5FU) is associated with best tumor response in comparison to bolus 5-FU and perhaps, a slight increase of overall survival. There are some non-inferiority trials comparing oral fluoropyrimidines with bolus or cIV of 5FU, but there is still no definitive evidence of equivalence. This systematic review evaluated the efficacy of oral fluoropyrimidines compared to bolus or cIV administration of 5FU in colorectal cancer. Methods: PubMed, EMBASE, CENTRAL and LILACS databases were searched. Eligible studies were randomized trials (RCTs) comparing chemotherapy regimens containing oral fluoropyrimidines (capecitabine, UFT or Tegafur) and 5FU (bolus or cIV) in patients with colorectal cancer. The primary outcome was overall survival (OS). Secondary outcomes included response rate (RR), progression-free survival (PFS) and disease-free-survival (DFS). Hazard Ratio (HR) and Odds Ratio (OR) with fixed effect model were used for meta- analysis and were expressed with 95% confidence intervals (CI). Results: We included results from 20 RCTs, with a total of 14,779 patients. Compared to cIV of 5FU, capecitabine resulted in lower RR (OR 0.82; 95% CI 0.72 to 0.95; p=0.006), shorter PFS (HR 1.09; 95% CI 1.01 to 1.17; p=0.02) and was associated with a non- significant reduction in OS (HR 1.05; 95%CI 0.97 to 1.14; p=0.23). Compared to bolus 5FU, capecitabine resulted in lower RR (OR 0.80; 95% CI 0.65 to 0.98; p=0.004), but similar OS and PFS. Compared to bolus 5FU, the use of other fluoropyrimidines resulted in similar RR, OS and PFS. Conclusions: Oral fluoropyrimidines are equivalent to bolus 5FU in terms of efficacy, but provides less benefit than cIV 5FU. Combination chemotherapy with cIV 5FU remains the first choice for patients with colorectal cancer. [Table: see text]

Risk for developing brain metastases from colorectal cancer in long-term survivors with lung metastases and KRAS mutations.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14574-e14574 ◽  
Author(s):  
Federica Zoratto ◽  
Fotios Loupakis ◽  
Chiara Cremolini ◽  
Lisa Salvatore ◽  
Marta Schirripa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
At Risk ◽  
Brain Metastases ◽  
Survival Time ◽  
Null Hypothesis ◽  
Lung Metastases ◽  
Original Design ◽  
Kras Mutations ◽  
Exact Test ◽  
Molecular Features

e14574 Background: Brain metastases (BM) occur in 1-4% of metastatic colorectal cancer (mCRC) patients (pts). Retrospective series evidence that pts with a long survival from the diagnosis of mCRC are more frequently affected. Moreover, BM seem to be associated with lung metastases and KRAS activating mutations. The identification of clinical and molecular features correlated with BM may allow to define a subgroup more likely to develop BM, thus to benefit from neuroimaging follow up and early treatment. Methods: We prospectively tested the hypothesis that a higher incidence of BM occurs in a population of mCRC pts with a survival time from the diagnosis of mCRC ≥10 months, lung metastases and KRAS exons 2 and 3 mutations. Given a reported incidence of BM in unselected mCRC of around 3% (H0) and expecting an incidence in an “at risk” population selected on the basis of the 3 above reported features of 10% (H1), setting α and β errors to 0.05 and 0.10 respectively, we adopted the Fleming single-stage design for calculating the sample size of our analysis. The null hypothesis would have been rejected if at least 7 out of 104 “at risk” pts had developed BM. Results: 623 pts, enrolled in clinical trials treated with first-line chemotherapy and bevacizumab, were included in the overall study population in order to identify 105 (16.9%) pts who simultaneously had a survival time from the diagnosis of mCRC ≥10 months, lung metastases and KRAS exons 2 and 3 mutations. 26 (4.2%) out of 623 pts developed BM. 14 out 518 (2.7%) not “at risk” pts presented BM, while 12 out of 105 (11.4%) “at risk” pts did. The incidence of BM in the two groups differed significantly (Fisher’s exact test, p=0.0004). The null hypothesis was rejected according to the original design. Conclusions: This analysis confirms the hypothesis that the concomitant presence of the 3 analyzed risk factors increases the probability of developing BM in mCRC patients. Based on these data, the opportunity to consider a neuroimaging exam, such as brain CT scan or MRI, in this specific population might be taken into account in order to provide an early diagnosis of BM and therefore the most appropriate therapy in an asymptomatic phase.

Sign in / Sign up

Export Citation Format

Share Document