Treatment and Outcomes of Oligometastatic Colorectal Cancer Limited to Lymph Node Metastases,Clinical Colorectal Cancer

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Treatment and Outcomes of Oligometastatic Colorectal Cancer Limited to Lymph Node Metastases
Clinical Colorectal Cancer ( IF 3.4 ) Pub Date : 2021-06-25 , DOI: 10.1016/j.clcc.2021.06.003
Vinod Kalapurackal Mathai ₁ , Soe Yu Aung ₂ , Vanessa Wong ₃ , Catherine Dunn ₄ , Jeremy Shapiro ₅ , Azim Jalali ₆ , Rachel Wong ₇ , Margaret Lee ₈ , Jeanne Tie ₉ , Sumitra Ananda ₃ , Suzanne Kosmider ₁₀ , Stephanie H Lim ₁₁ , Susan Caird ₁₂ , Matthew Burge ₁₃ , Andrew Dean ₁₄ , Peter Gibbs ₁₅ , Louise Nott ₁₆

Affiliation

Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia.
Department of Medical Oncology, Rockhampton Hospital, Queensland, Australia.
Walter and Eliza Hall Institute of Medical Research, Victoria, Australia.
Walter and Eliza Hall Institute of Medical Research, Victoria, Australia; Peter MacCallum Cancer Centre, Victoria, Australia.
Cabrini Haematology and Oncology Centre, Victoria, Australia.
Walter and Eliza Hall Institute of Medical Research, Victoria, Australia; Department of Medical Oncology, Western Hospital, Victoria, Australia; Latrobe Regional Hospital, Victoria, Australia.
Walter and Eliza Hall Institute of Medical Research, Victoria, Australia; Department of Medical Oncology, Eastern Health, Victoria, Australia; Monash University, Eastern Health Clinical School, Victoria, Australia.
Walter and Eliza Hall Institute of Medical Research, Victoria, Australia; Department of Medical Oncology, Western Hospital, Victoria, Australia; Department of Medical Oncology, Eastern Health, Victoria, Australia; Monash University, Eastern Health Clinical School, Victoria, Australia.
Walter and Eliza Hall Institute of Medical Research, Victoria, Australia; Peter MacCallum Cancer Centre, Victoria, Australia; Department of Medical Oncology, Western Hospital, Victoria, Australia.
Department of Medical Oncology, Western Hospital, Victoria, Australia.
Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia.
Gold Coast University hospital, Queensland, Australia.
Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia.
St John of God Subiaco, Western Australia, Australia.
Walter and Eliza Hall Institute of Medical Research, Victoria, Australia; Department of Medical Oncology, Western Hospital, Victoria, Australia.
Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia; Menzies Research Institute, Tasmania, Australia.

Introduction

The optimal management of isolated distant lymph node metastases (IDLNM) from a colorectal primary, is not clearly established. We aimed to analyze the outcomes of patients with IDLNM treated with systemic therapies plus locoregional therapy with curative intent versus systemic therapies with palliative intent.

Materials & Methods

Clinical data were collected and reviewed from the Treatment of Recurrent and Advanced Colorectal Cancer registry, a prospective, comprehensive registry for metastatic colorectal cancer (mCRC) treated at multiple tertiary hospitals across Australia. Clinicopathological characteristics, treatment modalities and survival outcomes were analyzed in patients with IDLNM and compared to patients with disease at other sites.

Results

Of 3408 mCRC patients diagnosed 2009 to 2020, with median follow-up of 38.0 months, 93 (2.7%) were found to have IDLNM. Compared to mCRC at other sites, patients with IDLNM were younger (mean age: 62.1 vs. 65.6 years, P = .02), more likely to have metachronous disease (57.0% vs. 38.9%, P < .01), be KRAS wild-type (74.6% vs. 53.9%, P< .01) and BRAF mutant (12.9% vs. 6.2%, P = .01). Amongst mCRC patients with IDLNM, 24 (25.8%) received treatment with curative intent and had a significantly better overall median survival than those treated with palliative intent (73.5 months vs. 23.2 months, P = .01). These 24 patients had an overall median survival similar (62.7 months, P = .82) to patients with isolated liver or lung metastases also treated with curative intent.

Conclusion

Curative treatment strategies (radiotherapy or surgery), with or without systemic therapy, should be considered for mCRC patients with IDLNM where appropriate as assessed by the multidisciplinary team.

中文翻译：

仅限于淋巴结转移的寡转移性结直肠癌的治疗和结果

介绍

结直肠原发灶孤立性远处淋巴结转移 (IDLNM) 的最佳治疗尚不明确。我们旨在分析接受全身治疗加局部区域治疗以治愈意图与全身治疗以姑息意图治疗的 IDLNM 患者的结果。

材料与方法

临床数据是从复发性和晚期结直肠癌治疗登记处收集和审查的，该登记处是在澳大利亚多家三级医院治疗的转移性结直肠癌 (mCRC) 的前瞻性综合登记处。对 IDLNM 患者的临床病理学特征、治疗方式和生存结果进行了分析，并与其他部位的疾病患者进行了比较。

结果

在 2009 年至 2020 年诊断出的 3408 名 mCRC 患者中，中位随访时间为 38.0 个月，发现 93 名（2.7%）患有 IDLNM。与其他部位的 mCRC 相比，IDLNM 患者更年轻（平均年龄：62.1 对 65.6 岁，P = .02），更可能患有异时性疾病（57.0% 对 38.9%，P < .01），是 KRAS野生型（74.6% 对 53.9%，P < .01）和 BRAF 突变型（12.9% 对 6.2%，P = .01）。在患有 IDLNM 的 mCRC 患者中，24 名 (25.8%) 接受了根治性治疗，并且总体中位生存期明显优于接受姑息性治疗的患者（73.5 个月对 23.2 个月，P = .01）。这 24 名患者的总体中位生存期相似（62.7 个月，P = .82) 对也接受治愈性治疗的孤立肝或肺转移患者。