Skip to main content

Advertisement

SpringerLink
Log in

Factors that influence survival in unresectable metastatic or locally advanced colorectal cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Half of patients with colorectal cancer (CRC) have metastasis during the whole course of the disease. Fewer than 10% of those are still alive at 5 years. Locally advanced CRC accounts for 7% to 33% of CRC relapses. Of these, only a small number of patients are resectable with a curative intent. Management of unresectable metastatic or locally advanced CRC is a significant challenge. In this study, we focus on patients with unresectable locally advanced or metastatic CRC and analyze survival rate and prognostic factors influencing the survival.

Methods

There were 277 patients identified. Several clinicopathologic parameters were evaluated. To determine the prognostic impact of the factors in survival, all parameters were tested from their relationship in Cox-regression model and Cox proportional hazards model. Survival curves were generated according to Kaplan–Meier method and the differences in survival were determined by employing the log-rank test.

Results

Three factors that influence the survival were identified: one or more than two organs involved (p = 0.041), higher carcinoembryonic antigen (CEA) level (p = 0.001), and different salvage treatment (p < 0.001). In Kaplan–Meier survival analysis, there were significant differences between patients with one and more than two organs involved (p = 0.027), different ranges of CEA level (p = 0.004), and different salvage treatment (p < 0.001).

Conclusions

We clearly demonstrated three factors that influence the survival, including more than two organs involved, higher CEA level, and different salvage treatment. The higher the CEA level and the more organs (≥2) involved, the worse the survival. Even in patients with unresectable metastatic or locally advanced, aggressive treatment with target therapy seems to have survival benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  2. Greene FL PD, Fleming ID. AJCC (American Joint Committee on Cancer) (2002) Cancer Staging Manual, 6th ed., p.114

  3. Ballantyne GH, Quin J (1993) Surgical treatment of liver metastases in patients with colorectal cancer. Cancer 71:4252–4266

    Article  PubMed  CAS  Google Scholar 

  4. Adson MA (1987) Resection of liver metastases—when is it worthwhile? World J Surg 11:511–520

    Article  PubMed  CAS  Google Scholar 

  5. McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB (1985) Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 72:34–37

    Article  PubMed  CAS  Google Scholar 

  6. Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE (1984) Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 53:1354–1362

    Article  PubMed  CAS  Google Scholar 

  7. Rich T, Gunderson LL, Lew R et al (1983) Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 52:1317–1329

    Article  PubMed  CAS  Google Scholar 

  8. Cohen AM, Minsky BD (1990) Aggressive surgical management of locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 33:432

    Article  PubMed  CAS  Google Scholar 

  9. Treatment of locally advanced unresectable or recurrent rectal cancer. Uptodate http://wwwuptodateorg accessed 2 July 2009 2009

  10. Choti M (2008) New paradigm in the treatment of hepatic colorectal metastases: a surgeon’s perspective. Commun Oncol 5:9–14

    Google Scholar 

  11. George D, Xuidema CJY, Shackelford’s Surgery of the Alimentary Tract, volume IV, Colon Rectum and Anus, Fifth Edition, p. 283

  12. Nielsen OS, Munro AJ, Tannock IF (1991) Bone metastases: pathophysiology and management policy. J Clin Oncol 9:509–524

    PubMed  CAS  Google Scholar 

  13. Nagorney DM (1987) hepatic resection for metastases from CRC. Probl Gen Surg 4:83

    Google Scholar 

  14. Rhomberg W, Eiter H, Hergan K, Schneider B (1994) Inoperable recurrent rectal cancer: results of a prospective trial with radiation therapy and razoxane. Int J Radiat Oncol Biol Phys 30:419–425

    PubMed  CAS  Google Scholar 

  15. Bendardaf R, Lamlum H, Pyrhonen S (2004) Prognostic and predictive molecular markers in colorectal carcinoma. Anticancer Res 24:2519–2530

    PubMed  CAS  Google Scholar 

  16. Carriquiry LA, Pineyro A (1999) Should carcinoembryonic antigen be used in the management of patients with colorectal cancer? Dis Colon Rectum 42:921–929

    Article  PubMed  CAS  Google Scholar 

  17. Gold P, Freedman SO (1965) Specific carcinoembryonic antigens of the human digestive system. J Exp Med 122:467–481

    Article  PubMed  CAS  Google Scholar 

  18. Sener SF, Imperato JP, Chmiel J, Fremgen A, Sylvester J (1989) The use of cancer registry data to study preoperative carcinoembryonic antigen level as an indicator of survival in colorectal cancer. CA Cancer J Clin 39:50–57

    Article  PubMed  CAS  Google Scholar 

  19. Hughes KS, Simon R, Songhorabodi S (1988) Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of Hepatic Metastases. Surgery 103:278–288

    Google Scholar 

  20. Bakalakos EA, Burak WE Jr, Young DC, Martin EW Jr (1999) Is carcino-embryonic antigen useful in the follow-up management of patients with colorectal liver metastases? Am J Surg 177:2–6

    Article  PubMed  CAS  Google Scholar 

  21. Goldstein MJ, Mitchell EP (2005) Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Cancer Invest 23:338–351

    PubMed  Google Scholar 

  22. Rougier P, Milan C, Lazorthes F et al (1995) Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer. Fondation Francaise de Cancerologie Digestive. Br J Surg 82:1397–1400

    Article  PubMed  CAS  Google Scholar 

  23. Stangl R, Altendorf-Hofmann A, Charnley RM, Scheele J (1994) Factors influencing the natural history of colorectal liver metastases. Lancet 343:1405–1410

    Article  PubMed  CAS  Google Scholar 

  24. Stelzner S, Hellmich G, Koch R, Ludwig K (2005) Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol 89:211–217

    Article  PubMed  Google Scholar 

  25. Scheithauer W, Rosen H, Kornek GV, Sebesta C, Depisch D (1993) Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. BMJ 306:752–755

    Article  PubMed  CAS  Google Scholar 

  26. Folprecht G, Grothey A, Alberts S, Raab HR, Köhne CH (2005) Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol 16:1311–1319

    Article  PubMed  CAS  Google Scholar 

  27. Nordlinger B, Sorbye H, Glimelius B et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomized controlled trial. Lancet 371:1007–1016

    Article  PubMed  CAS  Google Scholar 

  28. Falcone A, Ricci S, Brunetti I et al (2007) Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol 25:1670–1676

    Article  PubMed  CAS  Google Scholar 

  29. Grothey A, Hedrick EE, Mass RD, Sarkar S, Suzuki S, Ramanathan RK, Hurwitz HI, Goldberg RM, Sargent DJ (2008) Response-independent survival benefit in metastatic colorectal cancer: a comparative analysis of N9741 and AVF2107. J Clin Oncol 26:183–189

    Article  PubMed  CAS  Google Scholar 

  30. Hochster HS, Hart L, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL, Wong L, Fehrenbacher L, Abubakr Y, Saif MW, Schwartzberg L (2008) Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study. J Clin Oncol 26:3523–3529

    Article  PubMed  CAS  Google Scholar 

  31. Giantonio BJ, Catalano PJ, Meropol NJ et al (2007) 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 25:1539–1544

    Article  PubMed  CAS  Google Scholar 

  32. Tyagi P, Grothey A (2006) Commentary on a phase III trial of bevacizumab plus XELOX or FOLFOX4 for first-line treatment of metastatic colorectal cancer: the NO16966 trial. Clin Colorectal Cancer 6:261–264

    Article  PubMed  CAS  Google Scholar 

  33. Van Cutsem E, Nowacki M, Lang I et al (2007) Randomized phase III study of irintoecan and 5-FU/FA with or without cetuximab in the first-line treatment of patients with metastatic CRC(mCRC): the CRYSTAL trial (abstract). J Clin Oncol 25:164s

    Google Scholar 

  34. A. Venook DN, Hollis D, Sutherland S, Goldberg R, Alberts S, Benson A, Wade J, Schilsky R, Mayer R (2006) Phase III study of irinotecan/5FU/LV (FOLFIRI) or oxaliplatin/5FU/LV (FOLFOX) ± cetuximab for patients (pts) with untreated metastatic adenocarcinoma of the colon or rectum (MCRC): CALGB 80203 preliminary results. Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I Vol 24, No 18S (June 20 Supplement), 3509

  35. Sobrero AF, Maurel J, Fehrenbacher L et al (2008) EPIC: phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol 26:2311–2319

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veteran General Hospital, 386 Ta-Chung 1st RD, Kaohsiung, Taiwan, 81346, Republic of China

    Chao-Wen Hsu, Tai-Ming King, Hsin-Tai Wang & Jui-Ho Wang

  2. Faculty of medicine, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Pei-Tou, Taipei, 112, Taiwan, Republic of China

    Chao-Wen Hsu

Authors
  1. Chao-Wen Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tai-Ming King
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hsin-Tai Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jui-Ho Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jui-Ho Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hsu, CW., King, TM., Wang, HT. et al. Factors that influence survival in unresectable metastatic or locally advanced colorectal cancer. Int J Colorectal Dis 26, 1559–1566 (2011). https://doi.org/10.1007/s00384-011-1231-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1231-7

Keywords

Search

Navigation