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Open Access 01-08-2023 | Metastasis | Colorectal Cancer

Survival of Patients with Deficient Mismatch Repair Versus Proficient Mismatch Repair Metastatic Colorectal Cancer Receiving Curative-Intent Local Treatment of Metastases in a Nationwide Cohort

Authors: Koen Zwart, MD, Frederieke H. van der Baan, PhD, Cornelis J. A. Punt, MD, PhD, G. Emerens Wensink, MD, PhD, Karen Bolhuis, MD, Miangela M. Laclé, MD, PhD, Wilhelmina M. U. van Grevenstein, MD, PhD, Jeroen Hagendoorn, MD, PhD, Ignace H. de Hingh, MD, PhD, Miriam Koopman, MD, PhD, Geraldine Vink, MD, PhD, Jeanine Roodhart, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2023

Abstract

Background

It is unclear whether curative-intent local therapy of metastases is of similar benefit for the biological distinct subgroup of patients with deficient mismatch repair (dMMR) metastatic colorectal cancer (mCRC) compared with proficient mismatch repair (pMMR) mCRC.

Patients and Methods

In this nationwide study, recurrence-free (RFS) and overall survival (OS) were analyzed in patients with dMMR versus pMMR mCRC who underwent curative-intent local treatment of metastases between 2015 and 2018. Subgroup analyses were performed for resection of colorectal liver metastases (CRLM) and cytoreductive surgery ± hyperthermic intraperitoneal chemotherapy (CRS ± HIPEC). Multivariable regression was conducted.

Results

Median RFS was 11.1 months [95% confidence interval (CI) 8.5–41.1 months] for patients with dMMR tumors compared with 8.9 months (95% CI 8.1–9.8 months) for pMMR tumors. Two-year RFS was higher in patients with dMMR versus pMMR (43% vs. 21%). Results were similar within subgroups of local treatment (CRLM and CRS ± HIPEC). Characteristics differed significantly between patients with dMMR and pMMR mCRC; however, multivariable analysis continued to demonstrate dMMR as independent factor for improved RFS [hazard ratio (HR): 0.57, 95% CI 0.38–0.87]. Median OS was 33.3 months for dMMR mCRC compared with 43.5 months for pMMR mCRC, mainly due to poor survival of patients with dMMR in cases of recurrence in the preimmunotherapy era.

Conclusion

Patients with dMMR eligible for curative-intent local treatment of metastases showed a comparable to more favorable RFS compared with patients with pMMR, with a clinically relevant proportion of patients remaining free of recurrence. This supports local treatment as a valuable treatment option in patients with dMMR mCRC and can aid in shared decision-making regarding upfront local therapy versus immunotherapy.

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Title: Survival of Patients with Deficient Mismatch Repair Versus Proficient Mismatch Repair Metastatic Colorectal Cancer Receiving Curative-Intent Local Treatment of Metastases in a Nationwide Cohort
Authors: Koen Zwart, MD
Frederieke H. van der Baan, PhD
Cornelis J. A. Punt, MD, PhD
G. Emerens Wensink, MD, PhD
Karen Bolhuis, MD
Miangela M. Laclé, MD, PhD
Wilhelmina M. U. van Grevenstein, MD, PhD
Jeroen Hagendoorn, MD, PhD
Ignace H. de Hingh, MD, PhD
Miriam Koopman, MD, PhD
Geraldine Vink, MD, PhD
Jeanine Roodhart, MD, PhD
Publication date: 01-08-2023
Publisher: Springer International Publishing
Keywords: Metastasis
Colorectal Cancer
Colorectal Cancer
Published in: Annals of Surgical Oncology / Issue 11/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-13974-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Survival of Patients with Deficient Mismatch Repair Versus Proficient Mismatch Repair Metastatic Colorectal Cancer Receiving Curative-Intent Local Treatment of Metastases in a Nationwide Cohort

Abstract

Background

Patients and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusion

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