Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study
Colorectal cancer (CRC) patients frequently develop liver metastases. Different treatment strategies are available according to the timing of appearance, the burden of metastatic disease, and the performance status of the patient. Systemic treatment (ST) represents the cornerstone of metastatic dise...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/22/5513 |
| _version_ | 1797465782178807808 |
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| author | Stefano Granieri Christian Cotsoglou Alessandro Bonomi Lisa Salvatore Roberto Filippi Olga Nigro Fabio Gelsomino Ina Valeria Zurlo Ilaria Depetris Riccardo Giampieri Rossana Berardi Cristina Morelli Michele De Tursi Michela Roberto Elson Gjoni Alessandro Germini Nicola de Angelis Riccardo Memeo Antonio Facciorusso Ornella Garrone Daryl Ramai Michele Ghidini Alessandro Parisi |
| author_facet | Stefano Granieri Christian Cotsoglou Alessandro Bonomi Lisa Salvatore Roberto Filippi Olga Nigro Fabio Gelsomino Ina Valeria Zurlo Ilaria Depetris Riccardo Giampieri Rossana Berardi Cristina Morelli Michele De Tursi Michela Roberto Elson Gjoni Alessandro Germini Nicola de Angelis Riccardo Memeo Antonio Facciorusso Ornella Garrone Daryl Ramai Michele Ghidini Alessandro Parisi |
| author_sort | Stefano Granieri |
| collection | DOAJ |
| description | Colorectal cancer (CRC) patients frequently develop liver metastases. Different treatment strategies are available according to the timing of appearance, the burden of metastatic disease, and the performance status of the patient. Systemic treatment (ST) represents the cornerstone of metastatic disease management. However, in select cases, combined ST and surgical resection can lead to remarkable survival outcomes. In the present multicentric cohort study, we explored the efficacy of a conversion strategy in a selected population of left-sided RAS/BRAF wild-type CRC patients with liver-limited metastatic disease. Methods: The primary endpoint was to compare survival outcomes of patients undergoing ST not leading to surgery, liver resection after conversion ST, and hepatic resection with perioperative ST. Furthermore, we explored survival outcomes depending on whether the case was discussed within a multidisciplinary team. Results: Between 2012 and 2020, data from 690 patients respecting the inclusion criteria were collected. Among these, 272 patients were deemed eligible for the analysis. The conversion rate was 24.1% of cases. Fifty-six (20.6%) patients undergoing surgical resection after induction treatment (i.e., ultimately resectable) had a significant survival advantage compared to those receiving systemic treatment not leading to surgery (176 pts, 64.7%) (5-year OS 60.8% and 11.7%, respectively, Log Rank test <i>p</i> < 0.001; HR = 0.273; 95% CI: 0.16–0.46; <i>p</i> < 0.001; 5-year PFS 22.2% and 6.3%, respectively, Log Rank test <i>p</i> < 0.001; HR = 0.447; 95% CI: 0.32–0.63; <i>p</i> < 0.001). There was no difference in survival between ultimately resectable patients and those who had liver resection with perioperative systemic treatment (potentially resectable—40 pts) (5-year OS 71.1%, Log Rank test <i>p</i> = 0.311. HR = 0.671; 95% CI: 0.31–1.46; <i>p</i> = 0.314; 5-year PFS 25.7%, Log Rank test <i>p</i> = 0.305. HR = 0.782; 95% CI: 0.49–1.25; <i>p</i> = 0.306). Conclusions: In our selected population of left-sided RAS/BRAF wild-type colorectal cancer patients with liver-limited disease, a conversion strategy was confirmed to provide a survival benefit. Patients not deemed surgical candidates at the time of diagnosis and patients judged resectable with perioperative systemic treatment have similar survival outcomes. |
| first_indexed | 2024-03-09T18:26:28Z |
| format | Article |
| id | doaj.art-7e15f4be8c82477988aae314ee10d263 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T18:26:28Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-7e15f4be8c82477988aae314ee10d2632023-11-24T07:52:25ZengMDPI AGCancers2072-66942022-11-011422551310.3390/cancers14225513Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort StudyStefano Granieri0Christian Cotsoglou1Alessandro Bonomi2Lisa Salvatore3Roberto Filippi4Olga Nigro5Fabio Gelsomino6Ina Valeria Zurlo7Ilaria Depetris8Riccardo Giampieri9Rossana Berardi10Cristina Morelli11Michele De Tursi12Michela Roberto13Elson Gjoni14Alessandro Germini15Nicola de Angelis16Riccardo Memeo17Antonio Facciorusso18Ornella Garrone19Daryl Ramai20Michele Ghidini21Alessandro Parisi22General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, ItalyGeneral Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, ItalyGeneral Surgery Residency Program, University of Milan, Via Festa del Perdono 7, 20122 Milan, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, ItalyDepartment of Oncology, University of Turin, 10124 Torino, ItalyMedical Oncology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Viale Luigi Borri 57, 21100 Varese, ItalyDepartment of Oncology and Hematology, Division of Oncology, University Hospital of Modena, Via del Pozzo 71, 41125 Modena, ItalyMedical Oncology, “Vito Fazzi” Hospital, Piazza Filippo Muratore 1, 73100 Lecce, ItalyMedical Oncology, ASL TO4, Ospedale Civile di Ivrea, Piazza Credenza 2, 10015 Ivrea, ItalyClinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Via Conca 71, 60126 Ancona, ItalyClinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Via Conca 71, 60126 Ancona, ItalyMedical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, ItalyDepartment of Medical, Oral and Biotechnological Sciences and Center for Advance Studies and Technology (CAST), G. D’Annunzio University, Via dei Vestini 31, 66100 Chieti, ItalyOncology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, ItalyGeneral Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, ItalyGeneral Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, ItalyUnit of Digestive Surgery, Henri Mondor Hospital, AP-HP, 1 Rue Gustave Eiffel, 94000 Créteil, FranceUnit of Minimally Invasive and Robotic Digestive Surgery, Ospedale Regionale “F. Miulli”, 70124 Bari, ItalyGastroenterology Unit, Department of Medical Sciences, Ospedali Riuniti di Foggia, Viale Luigi Pinto 1, 71122 Foggia, ItalyOperative Unit of Medical Oncology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Sforza 28, 20122 Milan, ItalyDivision of Gastroenterology and Hepatology, University of Utah Health, 50 Medical Dr N, Salt Lake City, UT 84132, USAOperative Unit of Medical Oncology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Sforza 28, 20122 Milan, ItalyClinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Via Conca 71, 60126 Ancona, ItalyColorectal cancer (CRC) patients frequently develop liver metastases. Different treatment strategies are available according to the timing of appearance, the burden of metastatic disease, and the performance status of the patient. Systemic treatment (ST) represents the cornerstone of metastatic disease management. However, in select cases, combined ST and surgical resection can lead to remarkable survival outcomes. In the present multicentric cohort study, we explored the efficacy of a conversion strategy in a selected population of left-sided RAS/BRAF wild-type CRC patients with liver-limited metastatic disease. Methods: The primary endpoint was to compare survival outcomes of patients undergoing ST not leading to surgery, liver resection after conversion ST, and hepatic resection with perioperative ST. Furthermore, we explored survival outcomes depending on whether the case was discussed within a multidisciplinary team. Results: Between 2012 and 2020, data from 690 patients respecting the inclusion criteria were collected. Among these, 272 patients were deemed eligible for the analysis. The conversion rate was 24.1% of cases. Fifty-six (20.6%) patients undergoing surgical resection after induction treatment (i.e., ultimately resectable) had a significant survival advantage compared to those receiving systemic treatment not leading to surgery (176 pts, 64.7%) (5-year OS 60.8% and 11.7%, respectively, Log Rank test <i>p</i> < 0.001; HR = 0.273; 95% CI: 0.16–0.46; <i>p</i> < 0.001; 5-year PFS 22.2% and 6.3%, respectively, Log Rank test <i>p</i> < 0.001; HR = 0.447; 95% CI: 0.32–0.63; <i>p</i> < 0.001). There was no difference in survival between ultimately resectable patients and those who had liver resection with perioperative systemic treatment (potentially resectable—40 pts) (5-year OS 71.1%, Log Rank test <i>p</i> = 0.311. HR = 0.671; 95% CI: 0.31–1.46; <i>p</i> = 0.314; 5-year PFS 25.7%, Log Rank test <i>p</i> = 0.305. HR = 0.782; 95% CI: 0.49–1.25; <i>p</i> = 0.306). Conclusions: In our selected population of left-sided RAS/BRAF wild-type colorectal cancer patients with liver-limited disease, a conversion strategy was confirmed to provide a survival benefit. Patients not deemed surgical candidates at the time of diagnosis and patients judged resectable with perioperative systemic treatment have similar survival outcomes.https://www.mdpi.com/2072-6694/14/22/5513left colon cancerrectal cancerCRCcolorectal liver metastasesconversion therapyliver resection |
| spellingShingle | Stefano Granieri Christian Cotsoglou Alessandro Bonomi Lisa Salvatore Roberto Filippi Olga Nigro Fabio Gelsomino Ina Valeria Zurlo Ilaria Depetris Riccardo Giampieri Rossana Berardi Cristina Morelli Michele De Tursi Michela Roberto Elson Gjoni Alessandro Germini Nicola de Angelis Riccardo Memeo Antonio Facciorusso Ornella Garrone Daryl Ramai Michele Ghidini Alessandro Parisi Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study Cancers left colon cancer rectal cancer CRC colorectal liver metastases conversion therapy liver resection |
| title | Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study |
| title_full | Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study |
| title_fullStr | Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study |
| title_full_unstemmed | Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study |
| title_short | Conversion Strategy in Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer Patients with Unresectable Liver-Limited Disease: A Multicenter Cohort Study |
| title_sort | conversion strategy in left sided ras braf wild type metastatic colorectal cancer patients with unresectable liver limited disease a multicenter cohort study |
| topic | left colon cancer rectal cancer CRC colorectal liver metastases conversion therapy liver resection |
| url | https://www.mdpi.com/2072-6694/14/22/5513 |
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