Does colon cancer ever metastasize to bone first? a temporal analysis of colorectal cancer progression

Roth, Eira S; Fetzer, David T.; Barron, Bruce J.; Joseph, Usha A.; Gayed, Isis; Wan, David

doi:10.1186/1471-2407-9-274

Cited by 103 publications

(73 citation statements)

References 13 publications

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“…They also largely confirm the pattern of recurrence reported by other studies; [6][7][8] while the liver is the most frequent site of recurrence for both colonic and rectal tumors, there is a preponderance of solitary pulmonary metastasis in those with primary tumors in the rectum. This supports the contention that haematogenous spread via the iliac veins results in a higher incidence of lung metastases from rectal cancer.…”

Section: Discussionsupporting

confidence: 76%

“…1-4 Existing evidence on the pattern of recurrence after curative resection of colorectal cancer is limited to retrospective audits [5][6][7] and data from high quality randomised controlled trials is lacking. Trials of adjuvant therapies for colon and rectal cancer reveal certain information on patterns of recurrence but these are by definition limited to more advanced stage cancers requiring such treatments.…”

Section: Introductionmentioning

confidence: 99%

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Site and Stage of Colorectal Cancer Influence the Likelihood and Distribution of Disease Recurrence and Postrecurrence Survival

et al. 2016

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Running head: Analysis of recurrence in the FACS study Mini AbstractRecurrence is a frequent cause of mortality following treatment for colorectal cancer with curative intent. This retrospective cohort analysis examines patterns of recurrence, and factors determining post-recurrence survival, in a large cohort of accurately staged patients treated curatively for DukesÕ A-C primary colorectal cancer from the FACS randomised controlled trial. 1 Structured Abstract ObjectiveTo describe patterns of recurrence and post-recurrence survival (PRS) in a large cohort of accurately staged patients with DukesÕ A-C colorectal cancer (CRC). BackgroundRecurrence remains a frequent cause of mortality following the treatment of CRC with curative intent. Understanding the likelihood and site of recurrence informs adjuvant treatment and follow-up. MethodsRetrospective cohort analysis of data from the FACS (Follow-up after Colorectal Cancer Surgery) trial after a median 4.4 years follow-up; PRS was calculated using the Kaplan-Meier method. ResultsComplete data were available for 94% of patients; 189 (17%) had experienced recurrence.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Site and Stage of Colorectal Cancer Influence the Likelihood and Distribution of Disease Recurrence and Postrecurrence Survival

et al. 2016

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“…For example, rectal cancer has a well-established tendency to recur locally; however, the combination of total mesorectal excision and optimal chemoradiotherapy has reduced rates to < 10% in modern series. [58][59][60][61] Existing evidence on the pattern of recurrence after curative resection of colorectal cancer is limited to retrospective audits, [62][63][64] and data from high-quality randomised controlled trials are lacking. Trials of adjuvant therapies for colon and rectal cancer reveal certain information on patterns of recurrence, but these are by definition limited to more advanced-stage cancers requiring such treatments.…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial to assess the cost-effectiveness of intensive versus no scheduled follow-up in patients who have undergone resection for colorectal cancer with curative intent

Mant

Gray

Pugh

et al. 2017

Health Technol Assess

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Background Intensive follow-up after surgery for colorectal cancer is common practice but lacks a firm evidence base. Objective To assess whether or not augmenting symptomatic follow-up in primary care with two intensive methods of follow-up [monitoring of blood carcinoembryonic antigen (CEA) levels and scheduled imaging] is effective and cost-effective in detecting the recurrence of colorectal cancer treatable surgically with curative intent. Design Randomised controlled open-label trial. Participants were randomly assigned to one of four groups: (1) minimum follow-up (n = 301), (2) CEA testing only (n = 300), (3) computerised tomography (CT) only (n = 299) or (4) CEA testing and CT (n = 302). Blood CEA was measured every 3 months for 2 years and then every 6 months for 3 years; CT scans of the chest, abdomen and pelvis were performed every 6 months for 2 years and then annually for 3 years. Those in the minimum and CEA testing-only arms had a single CT scan at 12–18 months. The groups were minimised on adjuvant chemotherapy, gender and age group (three strata). Setting Thirty-nine NHS hospitals in England with access to high-volume services offering surgical treatment of metastatic recurrence. Participants A total of 1202 participants who had undergone curative treatment for Dukes’ stage A to C colorectal cancer with no residual disease. Adjuvant treatment was completed if indicated. There was no evidence of metastatic disease on axial imaging and the post-operative blood CEA level was ≤ 10 µg/l. Main outcome measures Primary outcome Surgical treatment of recurrence with curative intent. Secondary outcomes Time to detection of recurrence, survival after treatment of recurrence, overall survival and quality-adjusted life-years (QALYs) gained. Results Detection of recurrence During 5 years of scheduled follow-up, cancer recurrence was detected in 203 (16.9%) participants. The proportion of participants with recurrence surgically treated with curative intent was 6.3% (76/1202), with little difference according to Dukes’ staging (stage A, 5.1%; stage B, 7.4%; stage C, 5.6%; p = 0.56). The proportion was two to three times higher in each of the three more intensive arms (7.5% overall) than in the minimum follow-up arm (2.7%) (difference 4.8%; p = 0.003). Surgical treatment of recurrence with curative intent was 2.7% (8/301) in the minimum follow-up group, 6.3% (19/300) in the CEA testing group, 9.4% (28/299) in the CT group and 7.0% (21/302) in the CEA testing and CT group. Surgical treatment of recurrence with curative intent was two to three times higher in each of the three more intensive follow-up groups than in the minimum follow-up group; adjusted odds ratios (ORs) compared with minimum follow-up were as follows: CEA testing group, OR 2.40, 95% confidence interval (CI) 1.02 to 5.65; CT group, OR 3.69, 95% CI 1.63 to 8.38; and CEA testing and CT group, OR 2.78, 95% CI 1.19 to 6.49. Survival A Kaplan–Meier survival analysis confirmed no significant difference between arms (log-rank p = 0.45). The baseline-adjusted Cox proportional hazards ratio comparing the minimum and intensive arms was 0.87 (95% CI 0.67 to 1.15). These CIs suggest a maximum survival benefit from intensive follow-up of 3.8%. Cost-effectiveness The incremental cost per patient treated surgically with curative intent compared with minimum follow-up was £40,131 with CEA testing, £43,392 with CT and £85,151 with CEA testing and CT. The lack of differential impact on survival resulted in little difference in QALYs saved between arms. The additional cost per QALY gained of moving from minimum follow-up to CEA testing was £25,951 and for CT was £246,107. When compared with minimum follow-up, combined CEA testing and CT was more costly and generated fewer QALYs, resulting in a negative incremental cost-effectiveness ratio (–£208,347) and a dominated policy. Limitations Although this is the largest trial undertaken at the time of writing, it has insufficient power to assess whether or not the improvement in detecting treatable recurrence achieved by intensive follow-up leads to a reduction in overall mortality. Conclusions Rigorous staging to detect residual disease is important before embarking on follow-up. The benefit of intensive follow-up in detecting surgically treatable recurrence is independent of stage. The survival benefit from intensive follow-up is unlikely to exceed 4% in absolute terms and harm cannot be absolutely excluded. A longer time horizon is required to ascertain whether or not intensive follow-up is an efficient use of scarce health-care resources. Translational analyses are under way, utilising tumour tissue collected from Follow-up After Colorectal Surgery trial participants, with the aim of identifying potentially prognostic biomarkers that may guide follow-up in the future. Trial registration Current Controlled Trials ISRCTN41458548. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 32. See the NIHR Journals Library website for further project information.

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“…al., showed no patients with isolated osseous metastasis at the time of diagnosis [3] . All patients with BM also had metastasis to either liver or lung, as determined by combined PET and CT imaging [3] . In our study, there were 5 patients with solitary BM and no other apparent synchronous metastases.…”

Section: Discussionmentioning

confidence: 99%

The benefit of surgical management of colorectal carcinoma bone metastases

Satcher

Lin

Harun

et al. 2013

JST

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Background/Objective: Metastatic colorectal carcinoma to bone rarely requires surgical intervention, and is infrequently studied. Aggressive surgical resection is sometimes empirically recommended in these patients, although there is no proven benefit for patient survival. Our hypothesis was that there is survival advantage conferred by resecting bone metastases (BM) when surgery is necessary. Methods:We performed a retrospective review of a prospectively collected database and identified 39 patients with bone metastases in the appendicular skeleton requiring surgery. Patients underwent surgery because of intractable pain, impending pathologic fracture, and/or pathologic fracture at presentation.Results: Median survival after complete resection of bone metastasis was higher (8 months) than for patients who had surgery, but did not have bony metastases completely excised (3 months, p = 0.014); and in surgical patients who had solitary bone metastasis at presentation (p = 0.023) compared with multiple bone involvement. There were no perioperative deaths. Additional skeletal surgeries were only required for patients (4 out of 39) with local recurrences. In cases of local recurrence, the median time to progression was 19 months. Conclusions:Surgery for bone metastasis in colorectal carcinoma is well tolerated, and can be considered for palliative care. Compared with other surgical techniques, complete bone-metastasis resection is associated with longer overall survival, and with longer recurrence free survival.

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Does colon cancer ever metastasize to bone first? a temporal analysis of colorectal cancer progression

Cited by 103 publications

References 13 publications

Site and Stage of Colorectal Cancer Influence the Likelihood and Distribution of Disease Recurrence and Postrecurrence Survival

Site and Stage of Colorectal Cancer Influence the Likelihood and Distribution of Disease Recurrence and Postrecurrence Survival

A randomised controlled trial to assess the cost-effectiveness of intensive versus no scheduled follow-up in patients who have undergone resection for colorectal cancer with curative intent

The benefit of surgical management of colorectal carcinoma bone metastases

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