Chetana Lim1,2, Alexandre Doussot1, Michael Osseis1, Chady Salloum1, Concepcion Gomez Gavara1, Philippe Compagnon1,3, Francesco Brunetti1, Julien Calderaro3,4, Daniel Azoulay5,6. 1. Department of Digestive, Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France. 2. INSERM, U965, Paris, France. 3. INSERM, U955, Créteil, France. 4. Department of Pathology, Henri Mondor Hospital, Créteil, France. 5. Department of Digestive, Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France. daniel.azoulay@hmn.aphp.fr. 6. INSERM, U955, Créteil, France. daniel.azoulay@hmn.aphp.fr.
Abstract
BACKGROUND: The optimal strategy in patients with stage IVA colorectal cancer remains debated. This study was designed to compare the long-term outcomes and the pattern of recurrence following classical (CS) versus reverse (RS) strategy. METHODS: Data from all consecutive patients, who have completed the CS and RS, were retrospectively reviewed. A propensity score matching (PSM) was performed on 1:2 (RS:CS) ratio to obtain two groups matched for tumor characteristics. Survival and recurrence pattern were investigated before and after matching. RESULTS: The study population included 161 patients: 145 treated with CS versus 16 with RS. Five-year overall survival (OS, 51.5 vs. 42.7 %, p = 0.91) and recurrence-free survival (RFS, 20.5 vs. 20.6 %, p = 0.15) were not different between the two strategies. The median time to recurrence (TTR) whatever the site was significantly shorter in the RS group than in the CS group (3.5 vs. 13 months, p = 0.02). Extrahepatic recurrence was significantly more frequent (37.5 vs. 16.6 %; p = 0.04) and occurred earlier after treatment completion in the RS group than in the CS group (3.4 vs. 16.4 months, p = 0.009). Similar findings in terms of OS, RFS, median TTR whatever the site and proportion of extrahepatic recurrence were observed after PSM. CONCLUSIONS: Stage IVA colorectal cancer patients who have completed the CS or RS had similar OS. Extrahepatic recurrence is more frequent and occurs earlier after RS. Postoperative locoregional therapy and active follow-up strategies should be considered in RS patients.
BACKGROUND: The optimal strategy in patients with stage IVA colorectal cancer remains debated. This study was designed to compare the long-term outcomes and the pattern of recurrence following classical (CS) versus reverse (RS) strategy. METHODS: Data from all consecutive patients, who have completed the CS and RS, were retrospectively reviewed. A propensity score matching (PSM) was performed on 1:2 (RS:CS) ratio to obtain two groups matched for tumor characteristics. Survival and recurrence pattern were investigated before and after matching. RESULTS: The study population included 161 patients: 145 treated with CS versus 16 with RS. Five-year overall survival (OS, 51.5 vs. 42.7 %, p = 0.91) and recurrence-free survival (RFS, 20.5 vs. 20.6 %, p = 0.15) were not different between the two strategies. The median time to recurrence (TTR) whatever the site was significantly shorter in the RS group than in the CS group (3.5 vs. 13 months, p = 0.02). Extrahepatic recurrence was significantly more frequent (37.5 vs. 16.6 %; p = 0.04) and occurred earlier after treatment completion in the RS group than in the CS group (3.4 vs. 16.4 months, p = 0.009). Similar findings in terms of OS, RFS, median TTR whatever the site and proportion of extrahepatic recurrence were observed after PSM. CONCLUSIONS:Stage IVA colorectal cancerpatients who have completed the CS or RS had similar OS. Extrahepatic recurrence is more frequent and occurs earlier after RS. Postoperative locoregional therapy and active follow-up strategies should be considered in RSpatients.
Authors: Francesco Esposito; Chetana Lim; Antonio Sa Cunha; Patrick Pessaux; Francis Navarro; Daniel Azoulay Journal: World J Surg Date: 2018-12 Impact factor: 3.352
Authors: C Lim; A Doussot; M Osseis; F Esposito; C Salloum; J Calderaro; C Tournigand; D Azoulay Journal: Clin Transl Oncol Date: 2018-03-28 Impact factor: 3.405