Defining patient outcomes in stage IV colorectal cancer: a prospective study with baseline stratification according to disease resectability status

Abstract

Background: Stage IV colorectal cancer encompasses a broad patient population in which both curative and palliative management strategies may be used. In a phase II study primarily designed to assess the efficacy of capecitabine and oxaliplatin, we were able to prospectively examine the outcomes of patients with stage IV colorectal cancer according to the baseline resectability status. Methods: At enrolment, patients were stratified into three subgroups according to the resectability of liver disease and treatment intent: palliative chemotherapy (subgroup A), conversion therapy (subgroup B) or neoadjuvant therapy (subgroup C). All patients received chemotherapy with capecitabine 2000 mg m –2 on days 1–14 and oxaliplatin 130 mg m –2 on day 1 repeated every 3 weeks. Imaging was repeated every four cycles where feasible liver resection was undertaken after four or eight cycles of chemotherapy. Results: Of 128 enrolled patients, 74, 22 and 32 were stratified into subgroups A, B and C, respectively. Attempt at curative liver resection was undertaken in 10 (45%) patients in subgroup B and 19 (59%) in subgroup C. The median overall survival was 14.6, 24.5 and 52.9 months in subgroups A, B and C, respectively. For patients in subgroups B and C who underwent an attempt at curative resection, 3-year progression-free survival was 10% in subgroup B and 37% for subgroup C. Conclusions: This prospective study shows the wide variation in outcome according to baseline resectability status and highlights the potential clinical value of a modified staging system to distinguish between these patient subgroups.

Palliative Treatment of Colorectal Cancer with Secondary Metastasis Resection in Germany - Impact of the Multidisciplinary Treatment Approach on Prognosis and Cost: The Northern Bavaria IVOPAK I Project

“…The study conducted by Watkins et al [16] confirms the resectability status as an important prognostic factor. Despite the same treatment regimen, i.e.…”

“…Despite the same treatment regimen, i.e. XELOX, being applied in both groups of the latter study, the palliative patient collective (group A) had a median OS of 14.6 months, whereas this was 52.9 months in the patient group with primarily resectable distant metastases (group C) [16]. …”

“…In CRC, the treatment of histologically proven, primarily resectable distant liver and lung metastases differs distinctly from the treatment of distant metastases in a palliative situation [2,15,16]. …”

Macrophage inflammatory protein‐3 alpha (MIP‐3a) Is a novel serum prognostic marker in patients with colorectal cancer

“…Although multidisciplinary therapies have been performed appropriately and comprehensively, in reality there is a significant difference in prognosis of stage IV CRC or mCRC patients. In order to optimize the choice and timing of multidisciplinary therapies, prognostic markers should be needed for an appropriate patient stratification 6, 7.…”

Neoadjuvant Chemotherapy for Colorectal Liver Metastases

“…The study was halted early due to a high rate of thromboembolic complications. Meanwhile, Watkins et al (2010) employed a strategy of neoadjuvant capecitabine and oxaliplatin in a heterogeneous group of patients with stage IV colorectal cancer, among them 32 patients with resectable liver only disease. Liver resection was ultimately performed in 19 patients.…”