Treatment Strategies and Prognosis of Patients With Synchronous or Metachronous Colorectal Peritoneal Metastases: A Population-Based Study

Bakkers, Checca; Lurvink, Robin J.; Rijken, Anouk; Nienhuijs, Simon W.; Kok, N.F.M.; Creemers, G.J.; Verhoef, Cornelis; Lemmens, Valery; Erning, Felice N. van; Hingh, Ignace H. J. T. de

doi:10.1245/s10434-021-10190-z

Cited by 29 publications

(37 citation statements)

References 29 publications

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“…Although we found no significant differences in relation to the number of patients who underwent cytoreductive surgery and HIPEC in our study, we observed a higher survival rate in patients who underwent cytoreductive surgery and HIPEC with the presence of peritoneal metastasis (64% vs. 7% p = 0.00) with a significant difference in relation to the type of peritoneal metastasis (metachronous 57.1%, synchronous 42.8%, p = 0.00). No significant differences were found in relation to the disease-free interval, which agreed with various studies reported in the literature [25].…”

Section: Discussionsupporting

confidence: 92%

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Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer

Mendoza‐Moreno

Díez-Alonso

Matías‐García

et al. 2022

JCM

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Objectives: The aim of this study was to analyze the prognostic factors of survival in patients with peritoneal metastasis (PM) from colorectal cancer (CRC). The type of relationship between survival and the PM time of detection was used to determine whether it was synchronous with the primary tumor or metachronous. Patients and Methods: Retrospective observational study. It included patients treated for colorectal adenocarcinoma diagnosed between January 2005 and December 2019 who presented PM at the time of diagnosis or during follow-up. Variables, such as sex, age, differentiation grade, positive adenopathy (pN+), tumor size (pT), tumor location, mucinous component, peritoneal carcinomatosis index (PCI), and KRAS mutational status, were analyzed. Results: During the study period, 1882 patients were surgically treated for CRC in our hospital. Of these, 240 patients (12.8%) were included in the study after evidence of PM. The mean age was 67 ± 12 years (range: 32–92 years), and 114 patients were female (47.5%). The mean follow-up was 20 ± 13 months (median 12 months). The Kaplan–Meier survival at 36 months was higher in patients with metachronous PM (24% vs. 8%; p = 0.002), WT-KRAS tumors (31% vs. 15%; p < 0.001), N0 stage (30% vs. 19%; p < 0.001), T3 stage tumors (18% vs. 19% in T4A and 3% in T4B; p > 0.001), and tumors with classic adenocarcinoma histology (18% vs. 8%; p = 0.011). Patients with a PCI of 1–10 showed a likelihood of survival at 36 months of 56%, which was longer than that found in patients with a PCI of 11–20 (8%) or a PCI of >20 (0%) (p < 0.001). In the multiple regression analysis, the factors with an independent prognostic value were: poor grade of differentiation (HR 1.995; 95% CI: 1.294–3.077), KRAS mutation (HR 1.751; 95% CI: 1.188–2.581), PCI 11–20 (HR: 9.935; 95% CI: 5.204–18.966) and PCI > 20 (HR: 4.011; 95% CI: 2.291–7.023). Conclusions: PCI should continue as the as the most useful prognostic indicator in order to assess prognostic estimations as well as therapeutic and surgical decisions, but tumor grade and KRAS mutational status may help in the treatment decision process by providing complementary information. The time of PM detection did not achieve statistical significance in the multiple regression analysis.

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Section: Discussionsupporting

confidence: 92%

“…Kaplan-Meir estimation of OS at 36 months after diagnosis was 32% (median: 21 months; 95% CI: [16][17][18][19][20][21][22][23][24][25]. The results of the univariate survival analysis are shown in Table 2.…”

Section: Long-term Survivalmentioning

confidence: 99%

Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer

Mendoza‐Moreno

Díez-Alonso

Matías‐García

et al. 2022

JCM

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“…Approximately 4-6% of the patients with colorectal carcinoma (CRC) present with peritoneal metastases (PM) at the time of primary diagnosis (synchronous onset; s-PM). 1 – 3 Another 4-6% of the CRC patients will develop PM during follow-up (metachronous onset; m-PM). Patients with colorectal PM have a poor prognosis with a median survival of about 16 months in patients treated with systemic chemotherapy.…”

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confidence: 99%

Survival Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Patients with Synchronous Versus Metachronous Onset of Peritoneal Metastases of Colorectal Carcinoma

et al. 2022

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Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal metastases (PM) from colorectal carcinoma (CRC). Because of considerable morbidity, optimal patient selection is essential. This study was designed to determine the impact of the onset of PM (synchronous vs. metachronous) on survival outcomes after CRS-HIPEC. Methods Patients undergoing CRS-HIPEC for colorectal PM in two academic centers in the Netherlands between 2010 and 2020 were eligible for inclusion. Patients were classified as synchronous (s-PM, i.e., diagnosis at time of presentation, staging, or primary surgery) or metachronous onset (m-PM, i.e., diagnosis during follow-up) of colorectal PM. Survival outcomes were compared between groups by Kaplan–Meier survival and Cox regression analyses. Results Of 390 included patients, 179 (45.9%) had synchronous onset of colorectal PM. These patients more often presented with higher TN-stage and poor differentiation/signet cell histology. Treatment with perioperative chemotherapy was more common in s-PM patients. m-PM patients experienced more serious postoperative complications (Clavien-Dindo ≥ III). There was no significant difference in disease-free survival (DFS) between s-PM (median 9 months, interquartile range [IQR] 5–15) and m-PM patients (median 8 months, IQR 5–17). Overall survival (OS) was significantly shorter for s-PM (median 28 months, IQR 11–48) versus m-PM patients (median 33 months, IQR 18–66, p = 0.049). Synchronous onset of PM was not independently associated with OS in a multivariable analysis. Conclusions Synchronous onset of colorectal PM was associated with poor tumor characteristics and more advanced disease, but was not an independent predictor of survival outcomes after CRS-HIPEC.

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“…Historically, the presence of peritoneal carcinomatosis in patients with metastatic CRC has resulted in poor prognosis[ 13 , 14 ]. The median OS in patients treated with modern chemotherapy regimens, including targeted therapy, has ranged from 8 to 12 mo[ 17 ]. Bakkers et al [ 17 ] reported a population-based study with 7233 patients with metastatic CRC, of which 743 had peritoneal carcinomatosis.…”

Section: Discussionmentioning

confidence: 99%

“…The median OS in patients treated with modern chemotherapy regimens, including targeted therapy, has ranged from 8 to 12 mo[ 17 ]. Bakkers et al [ 17 ] reported a population-based study with 7233 patients with metastatic CRC, of which 743 had peritoneal carcinomatosis. The median OS for the 409 patients with synchronous peritoneal carcinomatosis was 8.1 mo compared to 12 mo for those with metachronous peritoneal metastasis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of peritoneal metastasis from colorectal cancer treated with first-line triplet chemotherapy

Bazarbashi¹,

Alghabban²,

Aseafan³

et al. 2022

WJCC

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BACKGROUND Peritoneal metastasis from colorectal cancer (CRC) carries a poor prognosis in most studies. The majority of those studies used either a single-agent or doublet chemotherapy regimen in the first-line setting. AIM To investigate the prognostic significance of peritoneal metastasis in a cohort of patients treated with triplet chemotherapy in the first-line setting. METHODS We retrospectively evaluated progression-free survival (PFS) and overall survival (OS) in 51 patients with metastatic CRC treated in a prospective clinical trial with capecitabine, oxaliplatin, irinotecan, and bevacizumab in the first-line setting according to the presence and absence of peritoneal metastasis. Furthermore, univariate and multivariate analyses for PFS and OS were performed to assess the prognostic significance of peritoneal metastasis at the multivariate level. RESULTS Fifty-one patients were treated with the above triplet therapy. Fifteen had peritoneal metastasis. The patient characteristics of both groups showed a significant difference in the sidedness of the primary tumor (left-sided primary tumor in 60% of the peritoneal group vs 86% in the nonperitoneal group, P = 0.03) and the presence of liver metastasis (40% for the peritoneal group vs 75% for the nonperitoneal group, P = 0.01). Univariate analysis for PFS showed a statistically significant difference for age less than 65 years ( P = 0.034), presence of liver metastasis ( P = 0.046), lung metastasis ( P = 0.011), and those who underwent metastasectomy ( P = 0.001). Only liver metastasis and metastasectomy were statistically significant for OS, with P values of 0.001 and 0.002, respectively. Multivariate analysis showed that age (less than 65 years) and metastasectomy were statistically significant for PFS, with P values of 0.002 and 0.001, respectively. On the other hand, the absence of liver metastasis and metastasectomy were statistically significant for OS, with P values of 0.003 and 0.005, respectively. CONCLUSION Peritoneal metastasis in patients with metastatic CRC treated with first-line triple chemotherapy does not carry prognostic significance at univariate and multivariate levels. Confirmatory larger studies are warranted.

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Treatment Strategies and Prognosis of Patients With Synchronous or Metachronous Colorectal Peritoneal Metastases: A Population-Based Study

Cited by 29 publications

References 29 publications

Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer

Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer

Survival Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Patients with Synchronous Versus Metachronous Onset of Peritoneal Metastases of Colorectal Carcinoma

Prognostic significance of peritoneal metastasis from colorectal cancer treated with first-line triplet chemotherapy

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