Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2018

01-06-2018 | Gastrointestinal Oncology

Prognostic Impact of R0 Resection and Targeted Therapy for Colorectal Cancer with Synchronous Peritoneal Metastasis

Authors: Dai Shida, MD, PhD, Takefumi Yoshida, MD, PhD, Taro Tanabe, MD, Shunsuke Tsukamoto, MD, PhD, Hiroki Ochiai, MD, PhD, Yukihide Kanemitsu, MD

Published in: Annals of Surgical Oncology | Issue 6/2018

Login to get access

Abstract

Background

The National Comprehensive Cancer Network guidelines recommend R0 resection and targeted therapy, a combination of cytotoxic and molecular targeted agents, such as bevacizumab, cetuximab, and panitumumab, for colorectal cancer with synchronous peritoneal metastasis (M1c). While these therapeutic strategies are drawing attention, their efficacy has not been fully examined.

Methods

The study population comprised 248 consecutive M1c patients who were treated at the National Cancer Center Hospital from 1997 to 2013. Multivariate analyses were performed to evaluate relationships between overall survival and R0 resection and targeted therapy using Cox proportional hazards regression models.

Results

The 3-year overall survival (3 yOS) was 19.5%, and median survival time (MST) was 16.2 months in 248 M1c patients. R0 resection was performed in 34 patients (14%), yielding a 3-year overall survival (OS) of 48.3% and median survival time (MST) of 29.9 months. Targeted therapy was performed in 54 patients (22%) at least once during the course of treatment, yielding a 3-yr OS of 38.2% and MST of 23.9 months. After adjusting for other key clinical factors, such as the number of organs involved with metastases, performance status, primary tumor site, and extent of peritoneal metastasis, both R0 resection and targeted therapy were independent factors associated with longer OS. Targeted therapy was associated with a significantly longer OS compared with multiple cytotoxic agent therapy [hazard ratio 0.65; 95% confidence interval (0.44–0.94); p = 0.02].

Conclusions

If achievable, R0 resection is a desirable therapeutic strategy for patients with M1c colorectal cancer. Moreover, targeted therapy might be the optimal chemotherapy in this patient population.
Appendix
Available only for authorised users
Literature
1.
UICC. TNM classification of malignant tumours eighth edition. New York: John Wiley & Sons, Ltd; 2017.
2.
Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17(12):1709–19.CrossRefPubMed
3.
Benson AB, 3rd, Venook AP, Cederquist L, et al. Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15(3):370–98.CrossRefPubMed
4.
Mulsow J, Merkel S, Agaimy A, Hohenberger W. Outcomes following surgery for colorectal cancer with synchronous peritoneal metastases. Br J Surg. 2011;98(12):1785–91.CrossRefPubMed
5.
Sugarbaker PH, Ryan DP. Cytoreductive surgery plus hyperthermic perioperative chemotherapy to treat peritoneal metastases from colorectal cancer: standard of care or an experimental approach? Lancet Oncol. 2012;13(8):e362–9.CrossRefPubMed
6.
Shida D, Tsukamoto S, Ochiai H, Kanemitsu Y. Long-term outcomes after R0 resection of synchronous peritoneal metastasis from colorectal cancer without cytoreductive surgery or hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2018;25(1):173–8.CrossRefPubMed
7.
Fakih MG. Metastatic colorectal cancer: current state and future directions. J Clin Oncol. 2015;33(16):1809–24.CrossRefPubMed
8.
Razenberg LG, van Gestel YR, Lemmens VE, de Hingh IH, Creemers GJ. Bevacizumab in addition to palliative chemotherapy for patients with peritoneal carcinomatosis of colorectal origin: a nationwide population-based study. Clin Colorectal Cancer. 2016;15(2):e41–6.CrossRefPubMed
9.
Stillwell AP, Ho YH, Veitch C. Systematic review of prognostic factors related to overall survival in patients with stage IV colorectal cancer and unresectable metastases. World J Surg. 2011;35(3):684–92.CrossRefPubMed
10.
Arnold D, Lueza B, Douillard JY, et al. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol. 2017;28(8):1713–29.CrossRefPubMed
11.
Vallicelli C, Cavaliere D, Catena F, et al. Management of peritoneal carcinomatosis from colorectal cancer: review of the literature. Int J Colorectal Dis. 2014;29(8):895–8.CrossRefPubMed
12.
Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma (8th edn). Tokyo: Kanehara & Co., Ltd; 2013.
13.
Kobayashi H, Kotake K, Sugihara K, Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the C, Rectum. Enhancing the objectivity of the Japanese classification of peritoneal metastases from colorectal cancer. Jpn J Clin Oncol. 2014;44(10):898–902.CrossRefPubMed
14.
Shida D, Tsukamoto S, Ochiai H, Kanemitsu Y. Long-term outcomes after R0 resection of synchronous peritoneal metastasis from colorectal cancer without cytoreductive surgery or hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2017;25(1):173–178.
15.
Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2017;23(1):1–34.
16.
Sato H, Maeda K, Kotake K, Sugihara K, Takahashi H. Factors affecting recurrence and prognosis after R0 resection for colorectal cancer with peritoneal metastasis. J Gastroenterol. 2016;51(5):465–72.CrossRefPubMed
17.
Noura S, Ohue M, Ito Y, et al. New staging system for colorectal cancer patients with synchronous peritoneal metastasis in accordance with the Japanese classification of colorectal carcinoma: a multi-institutional study. Dig Surg. 2016;33(1):66–73.CrossRefPubMed
18.
Kobayashi H, Kotake K, Sugihara K. Outcomes of surgery without HIPEC for synchronous peritoneal metastasis from colorectal cancer: data from a multi-center registry. Int J Clin Oncol. 2014;19(1):98–105.CrossRefPubMed
19.
Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28(1):63–8.CrossRefPubMed
20.
Ihemelandu C, Sugarbaker PH. Management for peritoneal metastasis of colonic origin: role of cytoreductive surgery and perioperative intraperitoneal chemotherapy: a single institution’s experience during two decades. Ann Surg Oncol. 2017;24(4):898–905.CrossRefPubMed
21.
Elias D, Glehen O, Pocard M, et al. A comparative study of complete cytoreductive surgery plus intraperitoneal chemotherapy to treat peritoneal dissemination from colon, rectum, small bowel, and nonpseudomyxoma appendix. Ann Surg. 2010;251(5):896–901.CrossRefPubMed
22.
Shida D, Hamaguchi T, Ochiai H, et al. Prognostic impact of palliative primary tumor resection for unresectable stage 4 colorectal cancer: using a propensity score analysis. Ann Surg Oncol. 2016;23(11):3602–8.CrossRefPubMed
23.
Tarantino I, Warschkow R, Worni M, et al. Prognostic relevance of palliative primary tumor removal in 37,793 metastatic colorectal cancer patients: a population-based, propensity score-adjusted trend analysis. Ann Surg. 2015;262(1):112–20.CrossRefPubMed
24.
Allegra CJ, Yothers G, O’Connell MJ, et al. Phase III trial assessing bevacizumab in stages II and III carcinoma of the colon: results of NSABP protocol C-08. J Clin Oncol. 2011;29(1):11–6.CrossRefPubMed
25.
Alberts SR, Sargent DJ, Nair S, et al. Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA. 2012;307(13):1383–93.CrossRefPubMedPubMedCentral
26.
Taieb J, Tabernero J, Mini E, et al. Oxaliplatin, fluorouracil, and leucovorin with or without cetuximab in patients with resected stage III colon cancer (PETACC-8): an open-label, randomised phase 3 trial. Lancet Oncol. 2014;15(8):862–73.CrossRefPubMed
Metadata
Title
Prognostic Impact of R0 Resection and Targeted Therapy for Colorectal Cancer with Synchronous Peritoneal Metastasis
Authors
Dai Shida, MD, PhD
Takefumi Yoshida, MD, PhD
Taro Tanabe, MD
Shunsuke Tsukamoto, MD, PhD
Hiroki Ochiai, MD, PhD
Yukihide Kanemitsu, MD
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6436-3

Other articles of this Issue 6/2018

Annals of Surgical Oncology 6/2018 Go to the issue

Colorectal Cancer

Analysis of the Vascular Interrelationships Among the First Jejunal Vein, the Superior Mesenteric Artery, and the Middle Colic Artery

Head and Neck Oncology

Analysis and Comparison of the 8th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System in Cutaneous and Oral Squamous Cell Cancer of the Head and Neck

Gastrointestinal Oncology

Centralization of Esophagectomy in the United States: Might It Benefit Underserved Populations?

Gastrointestinal Oncology

Prevalence and Prognostic Significance of Extramural Venous Invasion in Patients with Locally Advanced Esophageal Cancer

Breast Oncology

‘Under’ Surveillance: Impact of Race and Socioeconomic Status on Post-Treatment Breast Cancer Imaging

Gastrointestinal Oncology

Efficacy of Endoscopic Management for Early Remnant Gastric Cancer: Is Completion Gastrectomy Truly Necessary in Cases with Marginally Noncurative Histopathologic Features?