Peritoneal Carcinomatosis and Multi-Organ Metastases are Prognostic Factors in Colorectal Cancer: A Retrospective Analysis

• Omar Youssef

  The University of Helsinki, Faculty of Medicine, Department of Pathology, Helsinki, Finland

• Virinder Kaur Sarhadi

  The University of Helsinki, Faculty of Medicine, Department of Pathology, Helsinki, Finland

• Lauri Lehtimäki

  The University of Helsinki, Faculty of Medicine, Department of Pathology, Helsinki, Finland

• Milja Tikkanen

  The University of Helsinki, Faculty of Medicine, Department of Pathology, Helsinki, Finland

• Arto Kokkola

  The HUCH Gastrointestinal Clinic, Helsinki University Hospital, Helsinki, Finland

• Pauli Puolakkainen

  The HUCH Gastrointestinal Clinic, Helsinki University Hospital, Helsinki, Finland

• Gemma Armengol

  Unit of Biological Anthropology, Department of Animal Biology, Plant Biology and Ecology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain

• Sakari Knuutila

  The University of Helsinki, Faculty of Medicine, Department of Pathology, Helsinki, Finland

 Background: Peritoneal carcinomatosis and multi-organ metastases might be prognostic factors in patients with advanced colorectal cancer and inoperable metastases at diagnosis.

Methods: A retrospective study was performed to examine the relationship between patient clinical characteristics and prognosis in patients with colorectal cancer and indication for first-line systemic chemotherapy.

Results: One hundred and twelve patients were accrued. According to univariate analysis, peritoneal carcinomatosis, lack of primary tumour resection and multi-organ metastases were associated with poor overall survival. According to multivariate analysis, patients with peritoneal carcinomatosis and patients with multi-organ metastases had a shorter overall survival (12 vs 27.0 months, p<0.001 and 14,6 vs 27 months, p=0.007, respectively).

Conclusions: Our results indicate that presence of peritoneal carcinomatosis and multi-organ metastases are independent predictors of poor outcome for patients with colorectal cancer undergoing first line treatment with standard chemotherapy.

Surveillance, Epidemiology and End Results (SEER) Program [homepage on the Internet]. Available from www.seer.cancer.gov. Stat Database: Incidence-SEER 17. Nov 2006 Sub (1973-2004).

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual (7th ed), Eds. New York, NY: Springer 2010; p. 143.

Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin 2012; 62(1): 10-29. http://dx.doi.org/10.3322/caac.20138

Bleiberg H. Role of chemotherapy for advanced colorrectal cancer. New oportunities. Semin Oncol 1996; 23(1 Suppl 3): 42-50.

De Gramont A, Vignoud J, Tournigand C, Louvet C, André T, Varette C, et al. Oxaliplatin with high-dose leucovorin and 5- fluorouracil 48-hours continuous infusion in preatreated metastatic colorrectal cancer. Eur J Cancer 1997; 33(2): 214-9. http://dx.doi.org/10.1016/S0959-8049(96)00370-X

Ferrara N. Role of vascular endothelial growth factor in regulation of physiological angiogenesis. Am J Physiol Cell Physiol 2001; 280(6): C1358-66.

Ferrara N, Gerber HP, LeCouter J. The biology of VEGF and its receptors. Nat Med 2003; 9(6): 669-76. http://dx.doi.org/10.1038/nm0603-669

Jain RK. Normalizing tumor vasculature with anti-angiogenic therapy: a new paradigm for combination therapy. Nat Med 2001; 7(9): 987-9. http://dx.doi.org/10.1038/nm0901-987

Kabbinavar FF, Hambleton J, Mass RD, Hurwitz HI, Bergsland E, Sarkar S. Combined analysis of efficacy: the addition of bevacizumab to fluorouracil/leucovorin improves survival for patients with metastatic colorectal cancer. J Clin Oncol 2005; 23(16): 3706-12. http://dx.doi.org/10.1200/JCO.2005.00.232

Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004; 350(23): 2335-42. http://dx.doi.org/10.1056/NEJMoa032691

Giantonio BJ, Catalano PJ, Meropol NJ, O'Dwyer PJ, Mitchell EP, Alberts SR, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 2007; 25(12): 1539-44. http://dx.doi.org/10.1200/JCO.2006.09.6305

Saltz L, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatinbased chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008; 26(12): 2013-9. http://dx.doi.org/10.1200/JCO.2007.14.9930

Kuo LJ, Leu SY, Liu MC, Jian JJ, Hongiun Chen S, Chen CM. How aggressive should we be in patients with stage IV colorectal cancer? Dis Colon Rectum 2003; 46(12): 1646-1652. http://dx.doi.org/10.1007/BF02660770

Shah SA, Haddad R, Al-Sukhni W, Kim RD, Greig PD, Grant DR, et al. Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J Am Coll Surg 2006; 202(3): 468-75. http://dx.doi.org/10.1016/j.jamcollsurg.2005.11.008

Leichman L. The role of chemotherapy in the curative treatment of patients with liver metastases from colorectal cancer. Surg Oncol Clin N Am 2007; 16: 537-556. http://dx.doi.org/10.1016/j.soc.2007.04.003

Shepherd NA, Baxter KJ, Love SB. The prognostic importance of peritoneal involvement in colonic cancer: a prospective evaluation. Gastroenterology 1997; 112: 1096-1102. http://dx.doi.org/10.1016/S0016-5085(97)70119-7

Eker B, Ozaslan E, Karaca H, Berk V, Bozhurt O, Inanc M,

et al. Factors affecting prognosis in metastatic colorectal cancer patients. Asian Pac J Cancer Prev 2015; 16: 3015-21. http://dx.doi.org/10.7314/APJCP.2015.16.7.3015

Miyamoto Y, Hayashi N, Sakamoto Y, Ohuchi M, Tokunagam R, Kurashige J, et al. Predictors of long-term survival in patients with stage IV colorectal cancer with multi-organ metastases: a single center retrspective analysis. Int J Clin Oncol 2015; published online.

Yun HR, Lee WY, Lee WS, Cho YB, Yun SH, Chun HK. The prognostic factors of stage IV colorectal cancer and assessment of proper treatment according to the patient’s status. Int J Colorectal Dis 2007; 22(11): 1301-1310. http://dx.doi.org/10.1007/s00384-007-0315-x

Mijamoto Y, Hayashi N, Sakamoto Y, Oushi M, Tokunagam R, Kurashige J. Predctors of long-term survival in patients with stage IV colorrectal cancer with multi-organ metastases: a single-center retrospective análisis. Int J Clin Oncol published online: 07 May 2015.

Chua TC, Saxena A, Liauw W, Chu F, Morris DL. Hepatectomy and resection of concomitant extrahepatic disease for colorectal liver metastases—a systematic review. Eur J Cancer 2012; 48(12): 1757-1765. http://dx.doi.org/10.1016/j.ejca.2011.10.034

Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer 1989; 63: 364-367. http://dx.doi.org/10.1002/1097-0142(19890115)63:2<364::AID-CNCR2820630228>3.0.CO;2-V

Jimenez-Perez J, Caellas J, Garcia-Cano J, Vandervoort J, García Escribano OR, Barcenilla J, et al. Colonic Stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational restries. Am J Gastroenterol 2011; 106: 2174-2180. http://dx.doi.org/10.1038/ajg.2011.360

Haslinger M. Francescutti V, Attwood K, McCart JA, Fakih M, Kane JM 3rd, et al. A contemporany análisis of morbidity and outcomes in cytoredution/hyperthermic intraperitoneal chemoperfusion. Cancer Medicine 2013; 2: 334-342.

Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and pallliative surgery in patietns with peritoneal carcinomatosis of colorrectal cancer. J Clin Oncol 2003; 21: 3737-3743. http://dx.doi.org/10.1200/JCO.2003.04.187

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