H Isoniemi1, A Uutela1, A Nordin1, E Lantto2, I Kellokumpu3, A Ovissi4, J Kosunen4, R Kallio5, L M Soveri6,7, T Salminen8, A Ålgars9, A Lamminmäki10, P Halonen6, R Ristamäki9, J Räsänen11, H Karjula12, Y Vaalavuo13, M Lavonius14, P Osterlund6,8. 1. Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 2. Department of Radiology, Helsinki University Hospital, Päijät-Häme Central Hospital, Lahti, Finland. 3. Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland. 4. Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 5. Department of Oncology, Oulu University Hospital, Oulu, Finland. 6. Department of Oncology, Helsinki University Hospital, Helsinki, Finland. 7. Hyvinkää Hospital and Home Care, Hyvinkää, Finland. 8. Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland. 9. Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland. 10. Department of Oncology, Kuopio University Hospital, Kuopio, Finland. 11. Department of Thoracic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 12. Department of Surgery, Oulu University Hospital, Oulu, Finland. 13. Department of Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland. 14. Department of Surgery, Turku University Hospital and University of Turku, Turku, Finland.
Abstract
BACKGROUND: Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases. METHODS: The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival. RESULTS: Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0-1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0-1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively. CONCLUSION: Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.
BACKGROUND: Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases. METHODS: The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival. RESULTS: Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0-1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0-1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively. CONCLUSION: Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.
Authors: Andrew A Gumbs; Roland Croner; Eric Lorenz; Andrea Benedetti Cacciaguerra; Tzu-Jung Tsai; Lee Starker; Joe Flanagan; Ng Jing Yu; Elie Chouillard; Mohammad Abu Hilal Journal: Cancers (Basel) Date: 2022-08-29 Impact factor: 6.575
Authors: P Osterlund; S Kinos; P Pfeiffer; T Salminen; J J M Kwakman; J-E Frödin; C H Shah; H Sorbye; R Ristamäki; P Halonen; L M Soveri; E Heervä; A Ålgars; M Bärlund; H Hagman; R McDermott; M O'Reilly; R Röckert; G Liposits; R Kallio; P Flygare; A J Teske; E van Werkhoven; C J A Punt; B Glimelius Journal: ESMO Open Date: 2022-03-30