Long-term survival and tumor 5-FU sensitivity in patients with stage IV colorectal cancer and peritoneal dissemination

Abstract

Abstract. Among 125 patients with peritoneal dissemination (P1-3) of colorectal cancer, including those with other synchronous metastases, the 5-year overall survival (OS) rate was 13.3% for P1 patients (n=30), 12.8% for P2 patients (n=39), and 1.8% for P3 patients (n=56) (P1 vs. P2, p=N.S.; P2 vs. P3, p=0.02; P1 vs. P3, p=0.001), while the median survival time (MST) was 12.0, 14.1, and 3.1 months, respectively. The 5-year OS rates for patients who had peritoneal dissemination without other metastases were 17.6% (n=17), 12.5% (n=19), and 3.4% (n=28) (P1 vs. P2, p=N.S.; P2 vs. P3, p=N.S.; P1 vs. P3, p=0.039), while the MST was 25.1, 15.1, and 12.5 months, respectively. In the P3 short survival group (SSG; n=13), TS expression was high in 7.7% (1/13) and low in 92.3% (12/13) of tumors, while DPD expression was high in 38.5% (5/13) and low in 61.5% (8/13) of tumors. In the P3 long survival group (LSG; n=15), the corresponding values were 80.0% (12/15), 20.0% (3/15), 33.3% (5/15), and 66.7% (10/15). High TS and low DPD expression was found in only 7.7% (1/13) of the SSG tumors vs. 46.7% (7/15) of the LSG tumors (p=0.028). These results suggest that the prognosis of stage IV colorectal cancer with P3 peritoneal dissemination is extremely poor. In addition, patients fitting the SSG criteria are unlikely to respond to treatment with 5-FU+LV, and may need combination chemotherapy using CPT-11 and/or L-OHP.

The Association of Methylation in the Promoter of APC and MGMT and the Prognosis of Taiwanese CRC Patients

“…Fivefluorouracil (5-FU), a fluorinated pyrimidine analog, has been widely used in adjuvant chemotherapy for advanced CRC. However, the prognosis of CRC patients and the correlation between epigenetic changes in 5-FU adjuvant chemotherapy remain controversial (de Vos tot Nederveen Cappel et al, 2004;Crozier et al, 2006;Hasegawa et al, 2006). On the other hand, a relatively higher frequency of APC (germline or somatic) mutations in sporadic CRC has been reported in other ethnic groups (Esteller et al, 2000;Fearnhead et al, 2001;Kámory et al, 2008).…”

Prospective study on the recurrence/metastasis of stage II/III colorectal cancer and gastric cancer associated with occult neoplastic cells in lymph node sinuses: Three-year interim results

“…It has been reported that the incidence of postoperative peritoneal dissemination is about 10% for colorectal cancer, which is much lower than for gastric cancer (33). Although long-term survival of stage IV colorectal cancer patients without peritoneal dissemination has been reported, the prognosis is very poor after occurrence of peritoneal dissemination (33). Colorectal cancer differs from gastric cancer with respect to the mode of recurrence/metastasis and its biological behavior.…”

“…Stage II/III gastric cancer positive for LN metastasis is associated with peritoneal dissemination in at least 30-40% of patients who undergo surgery. There are two known mechanism of peritoneal dissemination, which are tumor cell dissemination to the peritoneal lining via lymphatics and direct spread of free cancer cells from sites of serosal exposure followed by survival/proliferation in the peritoneal cavity (33). It is also possible that gastric cancer may metastasize to intramural LNs, enter the greater omentum via lymphatics, and then be directly implanted into the abdominal wall and peritoneum (33).…”

“…There are two known mechanism of peritoneal dissemination, which are tumor cell dissemination to the peritoneal lining via lymphatics and direct spread of free cancer cells from sites of serosal exposure followed by survival/proliferation in the peritoneal cavity (33). It is also possible that gastric cancer may metastasize to intramural LNs, enter the greater omentum via lymphatics, and then be directly implanted into the abdominal wall and peritoneum (33). In the present study, four out of seven patients (57.1%) with ONC-negative stage II/III gastric cancer experienced recurrence, and three of these four patients had advanced recurrence with peritoneal dissemination.…”

Impacts of peritoneal cancer index on the survival outcomes of patients with colorectal peritoneal carcinomatosis

“…However the 5-year survival of these patients after systemic chemotherapy is still poor and ranges from 0-22%. [1,3,4,8,14,17,20,21,25,27,28,30,36] In the last two decades, the combination of cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) have been developed rapidly and considered as an innovative technique for CRPC. PIC consists of hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC).…”