PURPOSE: Advances in systemic chemotherapy have increased the resectability in colorectal cancer (CRC) associated with metastases even if it was initially unresectable. However, what determines the prognosis of stage IV CRC patients treated by preoperative therapy and surgery remains unclear. We attempted to identify prognostic factors in such CRC patients. METHODS: We reviewed stage IV CRC patients who underwent curative resection between December 2007 and May 2019. The patients who underwent conversion chemotherapy for initially unresectable disease and those who received neoadjuvant chemotherapy (NAC) for resectable synchronous metastases or neoadjuvant chemoradiotherapy (NACRT) for advanced lower rectal cancer with resectable metastases were included. Recurrence-free survival (RFS) and overall survival (OS) were examined by multivariate analyses using Cox proportional hazard models. The RFS and OS curves were analyzed according to postoperative adjuvant chemotherapy (AC). RESULTS: Among 70 patients who underwent curative surgery (34 men, mean age: 60 years old), 33 had initially unresectable disease, 23 received NAC, and 14 NACRT. By multivariate analyses, AC was an independent predictor for improved RFS and OS (hazard ratio = 0.29, p = 0.0002, and hazard ratio = 0.37, p = 0.025). Patients treated with AC showed improved RFS and OS than those without AC (2-year RFS rate = 30% vs 19%, p = 0.031, and 3-year OS rate = 87% vs 67%, p = 0.045). CONCLUSION: Because of its association with improved prognosis, AC should be considered for stage IV CRC patients after curative resection regardless of initial resectability status and preoperative therapy.
PURPOSE: Advances in systemic chemotherapy have increased the resectability in colorectal cancer (CRC) associated with metastases even if it was initially unresectable. However, what determines the prognosis of stage IV CRCpatients treated by preoperative therapy and surgery remains unclear. We attempted to identify prognostic factors in such CRCpatients. METHODS: We reviewed stage IV CRCpatients who underwent curative resection between December 2007 and May 2019. The patients who underwent conversion chemotherapy for initially unresectable disease and those who received neoadjuvant chemotherapy (NAC) for resectable synchronous metastases or neoadjuvant chemoradiotherapy (NACRT) for advanced lower rectal cancer with resectable metastases were included. Recurrence-free survival (RFS) and overall survival (OS) were examined by multivariate analyses using Cox proportional hazard models. The RFS and OS curves were analyzed according to postoperative adjuvant chemotherapy (AC). RESULTS: Among 70 patients who underwent curative surgery (34 men, mean age: 60 years old), 33 had initially unresectable disease, 23 received NAC, and 14 NACRT. By multivariate analyses, AC was an independent predictor for improved RFS and OS (hazard ratio = 0.29, p = 0.0002, and hazard ratio = 0.37, p = 0.025). Patients treated with AC showed improved RFS and OS than those without AC (2-year RFS rate = 30% vs 19%, p = 0.031, and 3-year OS rate = 87% vs 67%, p = 0.045). CONCLUSION: Because of its association with improved prognosis, AC should be considered for stage IV CRCpatients after curative resection regardless of initial resectability status and preoperative therapy.
Authors: Bernard Nordlinger; Halfdan Sorbye; Bengt Glimelius; Graeme J Poston; Peter M Schlag; Philippe Rougier; Wolf O Bechstein; John N Primrose; Euan T Walpole; Meg Finch-Jones; Daniel Jaeck; Darius Mirza; Rowan W Parks; Murielle Mauer; Erik Tanis; Eric Van Cutsem; Werner Scheithauer; Thomas Gruenberger Journal: Lancet Oncol Date: 2013-10-11 Impact factor: 41.316
Authors: J Y Douillard; S Siena; J Cassidy; J Tabernero; R Burkes; M Barugel; Y Humblet; G Bodoky; D Cunningham; J Jassem; F Rivera; I Kocákova; P Ruff; M Błasińska-Morawiec; M Smakal; J L Canon; M Rother; K S Oliner; Y Tian; F Xu; R Sidhu Journal: Ann Oncol Date: 2014-04-08 Impact factor: 32.976
Authors: René Adam; Valérie Delvart; Gérard Pascal; Adrian Valeanu; Denis Castaing; Daniel Azoulay; Sylvie Giacchetti; Bernard Paule; Francis Kunstlinger; Odile Ghémard; Francis Levi; Henri Bismuth Journal: Ann Surg Date: 2004-10 Impact factor: 12.969
Authors: D P Modest; T Denecke; J Pratschke; I Ricard; H Lang; M Bemelmans; T Becker; M Rentsch; D Seehofer; C J Bruns; B Gebauer; H I Modest; S Held; G Folprecht; V Heinemann; U P Neumann Journal: Eur J Cancer Date: 2017-11-28 Impact factor: 9.162