H Isoniemi, A Uutela, A Nordin, E Lantto, I Kellokumpu, A Ovissi, J Kosunen, R Kallio, L M Soveri, T Salminen, A Ålgars, A Lamminmäki, P Halonen, R Ristamäki, J Räsänen, H Karjula, Y Vaalavuo, M Lavonius, P Osterlund, Centralized repeated resectability assessment of patients with colorectal liver metastases during first-line treatment: prospective study, British Journal of Surgery, Volume 108, Issue 7, July 2021, Pages 817–825, https://doi.org/10.1093/bjs/znaa145
Centralized repeated resectability assessment of patients with colorectal liver metastases during first-line treatment : prospective study
|Author:||Isoniemi, H.1; Uutela, A.1; Nordin, A.1;|
1Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Department of Radiology, Helsinki University Hospital, Päijät-Häme Central Hospital, Lahti, Finland
3Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
4Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
5Department of Oncology, Oulu University Hospital, Oulu, Finland
6Department of Oncology, Helsinki University Hospital, Helsinki, Finland
7Hyvinkää Hospital and Home Care, Hyvinkää, Finland
8Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland
9Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
10Department of Oncology, Kuopio University Hospital, Kuopio, Finland
11Department of Thoracic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
12Department of Surgery, Oulu University Hospital, Oulu, Finland
13Department of Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
14Department of Surgery, Turku University Hospital and University of Turku, Turku, Finland
|Online Access:||PDF Full Text (PDF, 0.5 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2021100850414
John Wiley & Sons,
|Publish Date:|| 2021-10-08
Background: Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases.
Methods: The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival.
Results: Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0–1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0–1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively.
Conclusion: Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.
British journal of surgery
|Pages:||817 - 825|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
This work was supported by Finska Läkaresällskapet, the Finnish Cancer Foundation, the Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki and Turku University Hospitals; and the infrastructure, including the database, and study nurses by pharmaceutical companies (Amgen, Eli Lilly, Merck, Roche, Sanofi, and Servier). The study sponsors had no role in the design and conduct of the study, collection, analysis and interpretation of the data, or the decision to submit the manuscript for publication. R.K., L.M.S., T.S., A.Å., A.L., P.H., R.R., and P.O. have received consulting fees/honoraria from Amgen, Bayer, Eli Lilly, Celgene, Merck, Nordic Drugs, Roche, Sanofi, and Servier/Shire.
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited