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Postoperative chemotherapy is associated with prognosis of stage IV colorectal cancer treated with preoperative chemotherapy/chemoradiotherapy and curative resection

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Advances in systemic chemotherapy have increased the resectability in colorectal cancer (CRC) associated with metastases even if it was initially unresectable. However, what determines the prognosis of stage IV CRC patients treated by preoperative therapy and surgery remains unclear. We attempted to identify prognostic factors in such CRC patients.

Methods

We reviewed stage IV CRC patients who underwent curative resection between December 2007 and May 2019. The patients who underwent conversion chemotherapy for initially unresectable disease and those who received neoadjuvant chemotherapy (NAC) for resectable synchronous metastases or neoadjuvant chemoradiotherapy (NACRT) for advanced lower rectal cancer with resectable metastases were included. Recurrence-free survival (RFS) and overall survival (OS) were examined by multivariate analyses using Cox proportional hazard models. The RFS and OS curves were analyzed according to postoperative adjuvant chemotherapy (AC).

Results

Among 70 patients who underwent curative surgery (34 men, mean age: 60 years old), 33 had initially unresectable disease, 23 received NAC, and 14 NACRT. By multivariate analyses, AC was an independent predictor for improved RFS and OS (hazard ratio = 0.29, p = 0.0002, and hazard ratio = 0.37, p = 0.025). Patients treated with AC showed improved RFS and OS than those without AC (2-year RFS rate = 30% vs 19%, p = 0.031, and 3-year OS rate = 87% vs 67%, p = 0.045).

Conclusion

Because of its association with improved prognosis, AC should be considered for stage IV CRC patients after curative resection regardless of initial resectability status and preoperative therapy.

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References

  1. Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, Bechstein WO, Primrose JN, Walpole ET, Finch-Jones M, Jaeck D, Mirza D, Parks RW, Mauer M, Tanis E, van Cutsem E, Scheithauer W, Gruenberger T, EORTC Gastro-Intestinal Tract Cancer Group, Cancer Research UK, Arbeitsgruppe Lebermetastasen und–tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO), Australasian Gastro-Intestinal Trials Group (AGITG), Fédération Francophone de Cancérologie Digestive (FFCD) (2013) Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 14:1208–1215

    Article  CAS  Google Scholar 

  2. Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657 discussion 657-658

    Article  Google Scholar 

  3. Piso P, Arnold D, Glockzin G (2015) Challenges in the multidisciplinary management of stage IV colon and rectal cancer. Expert Rev Gastroenterol Hepatol 9:317–326

    Article  CAS  Google Scholar 

  4. Nozawa H, Ishihara S, Kawai K, Hata K, Kiyomatsu T, Tanaka T, Nishikawa T, Otani K, Yasuda K, Sasaki K, Kaneko M, Murono K (2018) Conversion to resection in patients receiving systemic chemotherapy for unresectable and/or metastatic colorectal cancer-predictive factors and prognosis. Clin Colorectal Cancer 17:e91–e97

    Article  Google Scholar 

  5. Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, Humblet Y, Bodoky G, Cunningham D, Jassem J, Rivera F, Kocákova I, Ruff P, Błasińska-Morawiec M, Smakal M, Canon JL, Rother M, Oliner KS, Tian Y, Xu F, Sidhu R (2014) Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol 25:1346–1355

    Article  CAS  Google Scholar 

  6. Modest DP, Denecke T, Pratschke J et al (2018) Surgical treatment options following chemotherapy plus cetuximab or bevacizumab in metastatic colorectal cancer-central evaluation of FIRE-3. Eur J Cancer 88:77–86

    Article  CAS  Google Scholar 

  7. Adam R, Kitano Y (2019) Multidisciplinary approach of liver metastases from colorectal cancer. Ann Gastroenterol Surg 3:50–56

    Article  Google Scholar 

  8. Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, Yamazaki K, Xu RH, Kim TW, Ismail F, Tan IB, Yeh KH, Grothey A, Zhang S, Ahn JB, Mastura MY, Chong D, Chen LT, Kopetz S, Eguchi-Nakajima T, Ebi H, Ohtsu A, Cervantes A, Muro K, Tabernero J, Minami H, Ciardiello F, Douillard JY (2018) Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol 29:44–70

    Article  CAS  Google Scholar 

  9. Shao YC, Chang YY, Lin JK et al (2013) Neoadjuvant chemotherapy can improve outcome of colorectal cancer patients with unresectable metastasis. Int J Color Dis 28:1359–1365

    Article  Google Scholar 

  10. Miyamoto Y, Hayashi N, Sakamoto Y, Ohuchi M, Tokunagam R, Kurashige J, Hiyoshi Y, Baba Y, Iwagami S, Yoshida N, Yoshida M, Baba H (2015) Predictors of long-term survival in patients with stage IV colorectal cancer with multi-organ metastases: a single-center retrospective analysis. Int J Clin Oncol 20:1140–1146

    Article  CAS  Google Scholar 

  11. Takahashi S, Konishi M, Kinoshita T, Gotohda N, Kato Y, Saito N, Sugito M, Yoshino T (2013) Predictors for early recurrence after hepatectomy for initially unresectable colorectal liver metastasis. J Gastrointest Surg 17:939–948

    Article  Google Scholar 

  12. Maeda Y, Shinohara T, Nagatsu A et al (2016) Long-term outcomes of conversion hepatectomy for initially Unresectable colorectal liver metastases. Ann Surg Oncol 23:S242–S248

    Article  Google Scholar 

Download references

Funding

This work was supported by Grants-in-Aid for Scientific Research (C: grant number; 17 K10620, C: grant number;17 K10621, C: grant number; 18 K07194, C: grant number; 19 K09114, and C: grant number; 19 K09115) from the Japan Society for the Promotion of Science, and by the Project for Cancer Research and Therapeutic Evolution (P-CREATE, grant number: JP19cm0106502) from the Japan Agency for Medical Research and Development (AMED).

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Hiroaki Nozawa, Hirofumi Sonoda, Hiroaki Ishii, Shigenobu Emoto, Koji Murono, Manabu Kaneko, Kazuhito Sasaki, Takeshi Nishikawa, Yasutaka Shuno, Toshiaki Tanaka, Kazushige Kawai, Keisuke Hata & Soichiro Ishihara

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  1. Hiroaki Nozawa
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  2. Hirofumi Sonoda
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  3. Hiroaki Ishii
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  4. Shigenobu Emoto
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  5. Koji Murono
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  6. Manabu Kaneko
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  9. Yasutaka Shuno
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  11. Kazushige Kawai
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  13. Soichiro Ishihara
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Correspondence to Hiroaki Nozawa.

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Nozawa, H., Sonoda, H., Ishii, H. et al. Postoperative chemotherapy is associated with prognosis of stage IV colorectal cancer treated with preoperative chemotherapy/chemoradiotherapy and curative resection. Int J Colorectal Dis 35, 177–180 (2020). https://doi.org/10.1007/s00384-019-03461-5

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  • DOI: https://doi.org/10.1007/s00384-019-03461-5

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