University of Oulu

Osterlund, P., Salminen, T., Soveri, L.-M., Kallio, R., Kellokumpu, I., Lamminmäki, A., Halonen, P., Ristamäki, R., Lantto, E., Uutela, A., Osterlund, E., Ovissi, A., Nordin, A., Heervä, E., Lehtomäki, K., Räsänen, J., Murashev, M., Aroviita, L., Jekunen, A., … Isoniemi, H. (2021). Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): A nationwide prospective intervention study. The Lancet Regional Health - Europe, 3, 100049.

Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO) : a nationwide prospective intervention study

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Author: Österlund, Pia1,2,3,4,5; Salminen, Tapio1,2; Soveri, Leena-Maija3,6;
Organizations: 1Tampere Univ Hosp, Dept Oncol, Teiskontie 35,POB 2000, Tampere 33520, Finland.
2Univ Tampere, Tampere, Finland.
3Helsinki Univ Hosp, Dept Oncol, Helsinki, Finland.
4Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.
5Karolinska Univ Hosp, Stockholm, Sweden.
6Hyvinkaa Hosp & Home Care, Dept Palliat Care, Hyvinkaa, Finland.
7Oulu Univ Hosp, Dept Oncol, Oulu, Finland.
8Univ Oulu, Oulu, Finland.
9Cent Hosp Cent Finland, Dept Gastrointestinal Surg, Jyyaskyla, Finland.
10Kuopio Univ Hosp, Dept Oncol, Kuopio, Finland.
11Univ Kuopio, Kuopio, Finland.
12Turku Univ Hosp, Dept Oncol, Turku, Finland.
13Univ Turku, Turku, Finland.
14Helsinki Univ Hosp, Dept Radiol, Helsinki, Finland.
15Univ Helsinki, Helsinki, Finland.
16Paijat Home Cent Hosp, Dept Radiol, Lahti, Finland.
17Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Helsinki, Finland.
18Uppsala Univ, Dept Immunol Genet & Pathol, Uppsala, Sweden.
19Akad Sjukhuset, Uppsala, Sweden.
20Helsinki Univ Hosp, Dept Thorac Surg, Helsinki, Finland.
21Satakunta Cent Hosp, Dept Oncol, Pori, Finland.
22Kanta Hame Cent Hosp, Dept Oncol, Hameenlinna, Finland.
23Vaasa Cent Hosp, Dept Oncol, Vaasa, Finland.
24Aland Cent Hosp, Dept Oncol, Mariehamn, Finland.
25Paijat Name Cent Hosp, Dept Oncol, Lahti, Finland.
26Cent Hosp Cent Finland, Dept Oncol, Jyvaskyla, Finland.
27Helsinki Univ Hosp, Dept Gastrointestinal Surg, Helsinki, Finland.
28StatConsulting, Nokia, Finland.
29South Carelia Cent Hosp, Dept Oncol, Lappeenranta, Finland.
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.1 MB)
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Language: English
Published: Elsevier, 2021
Publish Date: 2021-09-13


Background: Resection of colorectal cancer (CRC) metastases provides good survival but is probably underused in real-world practice.

Methods: A prospective Finnish nationwide study enrolled treatable metastatic CRC patients. The intervention was the assessment of resectability upfront and twice during first-line therapy by the multidisciplinary team (MDT) at Helsinki tertiary referral centre. The primary outcome was resection rates and survival.

Findings: In 2012–2018, 1086 patients were included. Median follow-up was 58 months. Multiple metastatic sites were present in 500 (46%) patients at baseline and in 820 (76%) during disease trajectory. In MDT assessments, 447 (41%) were classified as resectable, 310 (29%) upfront and 137 (18%) after conversion therapy. Six-hundred and ninety curative intent resections or local ablative therapies (LAT) were performed in 399 patients (89% of 447 resectable). Multiple metastasectomies for multisite or later developing metastases were performed in 148 (37%) patients. Overall, 414 liver, 112 lung, 57 peritoneal, and 107 other metastasectomies were performed. Median OS was 80·4 months in R0/1-resected (HR 0·15; CI95% 0·12–0·19), 39·1 months in R2-resected/LAT (0·39; 0·29–0·53) patients, and 20·8 months in patients treated with “systemic therapy alone” (reference), with 5-year OS rates of 66%, 40%, and 6%, respectively.

Interpretation: Repeated centralized MDT assessment in real-world metastatic CRC patients generates high resectability (41%) and resection rates (37%) with impressive survival, even when multisite metastases are present or develop later.

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Series: The Lancet. Regional health – Europe
ISSN: 2666-7762
ISSN-E: 2666-7762
ISSN-L: 2666-7762
Volume: 3
Article number: 100049
DOI: 10.1016/j.lanepe.2021.100049
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: We thank the patients and their families, the investigators, study personnel, and the hospitals that have participated in this study. This investigator-initiated study was supported by Finska Lakaresallskapet, Cancer Foundation Finland, The Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki, Turku and Satakunta Hospitals, Tampere University Hospital Fund (Tukisaatio and OOO-project), Research Fund of Helsinki University Hospital, and the infrastructure with database and study nurses partly by pharmaceutical companies (Amgen, Eli Lilly, Merck KGaA, Roche Finland, Sanofi and Servier). The funders had no role in the study design and conduct of the study, collection, analysis, interpretation of the data or in writing of this report. We thank the study units in Helsinki, Tampere and Oulu for monitoring the study and the OOO-project at Tampere University Hospital and Auria biobank at Turku University Hospital for data acquisition. We thank professor Halfdan Sorbye, professor Per Pfeiffer and professor Bengt Glimelius for sharing data on file for the population-based Scandinavian SPCRC study. The authors acknowledge professor Bengt Glimelius for sharing his expertise regarding study design, database content, data analysis and writing of the manuscript, professor Heikki Joensuu for critical comments on the manuscript, and the medical writers at Meducom BV, Wilko Coers, PhD and Sandy Field, PhD, who were compensated for their support by the first author.
Copyright information: © 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (