The influence of tumour site on prognosis in metastatic colorectal carcinomas with primary tumour resection

Merkel, Susanne; Schellerer, Vera; Wein, Axel; Semrau, Sabine; Geppert, Carol I.; Göhl, J.; Hohenberger, Werner; Weber, Klaus; Grützmann, Robert

doi:10.1007/s00384-018-3098-3

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…We recently demonstrated that 30.6% of patients with synchronous metastases of CRC can undergo treatment with curative intent, with an OS of 53.0% at 5 years [ 32 ]. Similarly, Merkel et al investigated the improvement in prognosis over time in a cohort of 937 patients who underwent primary tumor resection from the Erlangen Registry for Colorectal Carcinomas [ 33 ]. They found an increase in 2-year OS from 25.9% to 55.6% for the time periods 1985–1994 compared to 2005–2014.…”

Section: Discussionmentioning

confidence: 99%

Sidedness is not a prognostic factor in an unselected cohort of patients with colon cancer but prognosis for caecal carcinoma is worse – A multivariate analysis of a large single institution database

Stelzner,

Mehdorn,

Puffer

et al. 2024

Int J Colorectal Dis

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Purpose Sidedness has emerged as a prognostic factor for metastatic colorectal cancer treated with modern systemic therapies. This study investigates whether it is also relevant for an unselected patient cohort including all stages. Methods All consecutive patients admitted with colon cancer between 1995 and 2018 were retrieved from an institution-held database. Patients were divided into two cohorts. The first cohort included patients without distant metastases who were able to undergo curative resection. The second cohort presented with distant metastases (stage IV). Potentially prognostic factors were subjected to multivariate Cox Regression analysis. Results Overall, 1,606 patients met the inclusion and exclusion criteria. An R0-resection was achieved in 1,222 patients without distant metastases. Five-year cause-specific survival rate was 89.3% for this group. There was no difference between right- and left-sided cancers (88.2% vs. 90.1%, p = 0.220). However, prognosis of caecal carcinoma was significantly worse than that of all other sites combined (83.5% vs. 90.2%, p = 0.007). In multivariate analysis, pT-category, pN-category, grading, vascular invasion, emergency operation, adjuvant chemotherapy, and caecal carcinoma remained as independent prognostic factors. In the 384 patients with stage IV-disease, 3-year overall survival for right- vs. left-sided cancers differed only in univariate analysis (17.7% vs. 28.6%, p = 0.013). Conclusion In non-metastatic colon cancer, location in the caecum is an independent prognostic factor. In unselected patients with stage IV colon cancer, sidedness was not found to be a prognostic factor. Differentiation into right- and left-sided tumors may be simplistic, and further studies on the biological behavior of different colonic sites are warranted.

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Section: Discussionmentioning

confidence: 99%

Sidedness is not a prognostic factor in an unselected cohort of patients with colon cancer but prognosis for caecal carcinoma is worse – A multivariate analysis of a large single institution database

Stelzner,

Mehdorn,

Puffer

et al. 2024

Int J Colorectal Dis

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“…The cohort featured patients from a broad time frame (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). Primary treatment and therapy of tumor recurrences underwent significant changes at our institution during this period of time: FOLFOX and FOLFIRI chemotherapy regimens were launched from 1995 to 2004, while novel biologic agents, e.g., vascular endothelial growth factor (VEGF) antibodies and epidermal growth factor receptor (EGFR) inhibitors were introduced during 2005 and 2010 [34]. Hence, we included different time periods of surgery into our multivariate regression models to acknowledge the confounding effect of time-related changes.…”

Section: Discussionmentioning

confidence: 99%

Defining early recurrence in patients with resected primary colorectal carcinoma and its respective risk factors

Wiesmueller

Schuetz

Langheinrich

et al. 2021

Int J Colorectal Dis

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Purpose There is no evidence-based definition of early recurrence following resection of colorectal cancer. The purpose of this study is to define a point that discriminates between early and late recurrence in patients who have undergone colorectal cancer resection with curative intent and to analyze associated risk factors. Methods A retrospective single-center cohort study was performed at a university hospital recognized as a comprehensive cancer center, specializing in colorectal cancer surgery. Patient data were retrieved from a prospectively maintained institutional database. Included patients underwent resection for primary, non-metastatic colorectal carcinomas with curative intent between 1995 and 2010. Aims of the study were (1) to define the optimal cut-off point of recurrence-free survival based on overall survival using a minimum p value approach and (2) to identify patterns of initial recurrence and putative risk factors for early recurrence using regression models. Results Recurrence was diagnosed in 412 of 1893 patients. Statistical analysis suggested that a recurrence-free survival of 16 months could be used to distinguish between early and late recurrence based on overall survival (p < 0.001). Independent risk factors for early recurrence included advanced pT categories (pT3,4/ypT3,4) and positive lymph node status (pN+/ypN+). Early recurrence was independent of site of recurrence and was associated with worse prognosis. Conclusions Recurrence of colorectal carcinoma within 16 months after primary treatment should be labeled as “early.” Tumor categories pT3,4/ypT3,4 and positive lymph node status pN+/ypN+ are predictive of early recurrence.

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“…Primary tumor location is of prognostic importance in metastatic CRC [1,2]. Patients with right-sided disease have a significantly worse prognosis than those with left-sided CRC, independent of treatment [19][20][21][22]. The unfavorable prognosis of rightsided metastatic colon cancer was confirmed in metaanalysis and is universally accepted [1,2,22]; however, a biological explanation for the prognostic value of the location is currently lacking [3].…”

Section: Discussionmentioning

confidence: 99%

A Possible Distinct Molecular Subtype (Quintuple-Wildtype) of Metastatic Colorectal Cancer in First-Line Anti-EGFR Therapy with Cetuximab Plus FOLFIRI – Palliative Precision Therapy and a Multidisciplinary Treatment Approach: Interim Analysis of the IVOPAK II Trial with Early Results

et al. 2021

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Objective: The study aimed to prospectively evaluate a new molecular biomarker panel (KRAS, NRAS, BRAF, PIK3CA, and ERBB2) for palliative first-line treatment of colorectal cancer (CRC), including a multidisciplinary treatment approach. The rate of secondary metastasis resections was assessed. Patients and Methods: A total of 40 patients with definitively nonresectable metastatic CRC were enrolled from 10 centers before the interim analysis (June 2019) of the IVOPAK II trial (Interdisciplinary Care with Quality Control in Palliative Treatment of Colorectal Cancer). After determination of 5 molecular biomarkers in the tumor (KRAS, exons 2–4; NRAS, exons 2–4; BRAF V600E; PIK3CA; and ERBB2), patients in the IVOPAK II study received FOLFIRI plus cetuximab for all-RAS/quintuple-wildtype disease and FOLFIRI plus bevacizumab in the case of RAS mutations. The current article presents the early description of the clinical outcome of the interim analysis of IVOPAK II comparing the all-RAS/quintuple-wildtype and RAS-mutations populations, including a multidisciplinary-treated case report of a quintuple-wildtype patient. Results: The quintuple-wildtype population treated with FOLFIRI plus cetuximab in first-line exhibited a significantly higher response rate and enhanced early tumor shrinkage in the interim analysis than the RAS-mutations population, as well as a high rate of secondary metastatic resections. Conclusion: Initial results of this new biomarker panel (quintuple-wildtype) are promising for anti-EGFR therapy with cetuximab plus doublet chemotherapy (FOLFIRI) in first-line treatment of metastatic CRC. These results warrant confirmation with higher case numbers in the IVOPAK II trial.

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The influence of tumour site on prognosis in metastatic colorectal carcinomas with primary tumour resection

Abstract: In a surgical patient cohort undergoing primary tumour resection, significant differences in prognosis were observed between patients with metastatic right- and left-sided colorectal carcinomas.

Cited by 8 publications

References 37 publications

Sidedness is not a prognostic factor in an unselected cohort of patients with colon cancer but prognosis for caecal carcinoma is worse – A multivariate analysis of a large single institution database

Sidedness is not a prognostic factor in an unselected cohort of patients with colon cancer but prognosis for caecal carcinoma is worse – A multivariate analysis of a large single institution database

Defining early recurrence in patients with resected primary colorectal carcinoma and its respective risk factors

A Possible Distinct Molecular Subtype (Quintuple-Wildtype) of Metastatic Colorectal Cancer in First-Line Anti-EGFR Therapy with Cetuximab Plus FOLFIRI – Palliative Precision Therapy and a Multidisciplinary Treatment Approach: Interim Analysis of the IVOPAK II Trial with Early Results

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