#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Liver metastases from colon and rectal cancer in terms of differences in their clinical parameters


Authors: V. Liška 1,2;  M. Emingr 1;  M. Skála 1,2;  R. Pálek 1;  O. Troup 1;  P. Novák 1;  O. Vyčítal 1,2;  T. Skalický 1;  V. Třeška 1
Authors‘ workplace: Chirurgická klinika LF Univerzity Karlovy a FN Plzeň přednosta: prof. MUDr. V. Třeška, DrSc. 1;  Biomedicínské centrum LF Univerzity Karlovy v Plzni vedoucí pracoviště: doc. MUDr. M. Štengl, Ph. D. 2
Published in: Rozhl. Chir., 2016, roč. 95, č. 2, s. 69-77.
Category: Original articles

Overview

Introduction:
From the clinical point of view, rectal cancer and colon cancer are clearly different nosological units in their progress and treatment. The aim of this study was to analyse and clarify the differences between the behaviour of liver metastases from colon and rectal cancer. The study of these factors is important for determining an accurate prognosis and indication of the most effective surgical therapy and oncologic treatment of colon and rectal cancer as a systemic disease.

Method:
223 patients with metastatic disease of colorectal carcinoma operated at the Department of Surgery, University Hospital in Pilsen between January 1, 2006 and January 31, 2012 were included in our study. The group of patients comprised 145 men (65%) and 117 women (35%). 275 operations were performed. Resection was done in 177 patients and radiofrequency ablation (RFA) in the total of 98 cases. Our sample was divided into 3 categories according to the location of the primary tumor to C (colon), comprising 58 patients, S (c. sigmoideum) in 61 patients, and R (rectum), comprising 101 patients. Significance analysis of the studied factors (age, gender, staging [TNM classification], grading, presence of mucinous carcinoma, type of operation) was performed using ANOVA test. Overall survival (OS), disease-free interval (DFI) or no evidence of disease (NED) were estimated using Kaplan-Meier curves, which were compared with the log-rank and Wilcoxon tests.

Results:
As regards the comparison of primary origin of colorectal metastases in liver regardless of their treatment (resection and RFA), our study indicated that rectal liver metastases showed a significantly earlier recurrence than colon liver metastases (shorter NED/DFI). Among other factors, a locally advanced finding, further R2 resection of liver metastases and positivity of lymph node metastases were statistically significant for the prognosis of an early recurrence of the primary colon and sigmoid tumor. Furthermore, we proved that in patients with primary rectal carcinoma, DFI (after the resection of liver metastases) was not influenced by the positivity of lymph node metastases of primary tumor or locally advanced primary tumor. The other factors studied (time from diagnosis of organ metastases to primary operation, grading, sex or age) were not shown to be statistically significant for the prognosis of OS and DFI (colorectal cancer in total).

Conclusion:
As proven by our study, rectal cancer and colon cancer are two different nosological units with specific prognostic factors with respect to their liver metastases. These differences have not been fully understood yet and require further exploration and classification based not only on histopathological, immunohistochemical and clinical factors, but also on molecular biological parameters.

Key words:
colon carcinoma metastases − rectal carcinoma metastases − prognostic factors − overall survival – liver metastases


Sources

1. Dusek L, Muzik J, Maluskova D, et al. Cancer incidence and mortality in the Czech Republic. Klin Onkol 2014;27:406−23.

2. Nedrebø BS, Søreide K, Eriksen MT, et al. Excess mortality after curative surgery for colorectal cancer changes over time and differs for patients with colon versus rectal cancer. Acta Oncol 2013;52:933−40.

3. Gatta G, Faivre J, Capocaccia R, et al. Survival of colorectal cancer patients in Europe during the period 1978–1989. Eur J Cancer 1998;34:2176−83.

4. Rutter CM, Johnson EA, Feuer EJ, et al. Secular trends in colon and rectal cancer relative survival. J Natl Cancer Inst 2013;105:1806−13.

5. Xu FY, Zhai MJ, Dong JK, et al. Clinical pathological factors function differently in colonic and rectal cancer prognosis. Journal of Zhejiang University 2006;3:303–10.

6. Li M, Li JY, Zhao AL, et al. Colorectal cancer or colon and rectal cancer? Clinicopathological comparison between colonic and rectal carcinomas. Oncology 2007;73:52−7.

7. Kleespies A, Füessl KE, Seeliger H, et al. Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer. Int J Colorectal Dis 2009;24:1097−109.

8. Saha S, Monson KM, Bilchik A, et al. Comparative analysis of nodal upstaging between colon and rectal cancers by sentinel lymph node mapping: a prospective trial. Dis Colon Rectum 2004;47:1767−72.

9. Meimarakis G, Spelsberg F, Angele M, et al. Resection of pulmonary metastases from colon and rectal cancer: factors to predict survival differ regarding to the origin of the primary tumor. Ann Surg Oncol 2014;21:2563−72.

10. Lee H, Choi DW, Cho YB, et al. Recurrence pattern depends on the location of colon cancer in the patients with synchronous colorectal liver metastasis. Ann Surg Oncol 2014;21:1641−6.

11. Verhoef C, van der Pool AE, Nuyttens JJ, et al. The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum 2009;52:23−30.

12. Masoomi H, Kang CY, Chen A, et al. Predictive factors of in-hospital mortality in colon and rectal surgery. J Am Coll Surg 2012;215:255−61.

13. Kapiteijn E, Liefers GJ, Los LC, et al. Mechanisms of oncogenesis in colon versus rectal cancer. J Pathol 2001;195:171−8.

14. Frattini M, Balestra D, Suardi S, et al. Different genetic features associated with colon and rectal carcinogenesis. Clin Cancer Res 2004;10:4015–21.

15. Papadopoulos VN, Michalopoulos A, Netta S, et al. Prognostic significance of mucinous component in colorectal carcinoma. Tech Coloproctol 2004;8:123–5.

16. Roncucci L, Fante R, Losi L, et al. Survival for colon and rectal cancer in a population-based cancer registry. Eur J Cancer 1996;32A:295–302.

17. Wei EK, Giovannucci E, Wu K, et al. Comparison of risk factors for colon and rectal cancer. Int J Cancer 2004;108:433–42.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#