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Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer

Objectives: The aim of this study was to analyze the prognostic factors of survival in patients with peritoneal metastasis (PM) from colorectal cancer (CRC). The type of relationship between survival and the PM time of detection was used to determine whether it was synchronous with the primary tumor...

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Autores principales: Mendoza-Moreno, Fernando, Diez-Alonso, Manuel, Matías-García, Belén, Ovejero-Merino, Enrique, Gómez-Sanz, Remedios, Blázquez-Martín, Alma, Quiroga-Valcárcel, Ana, Vera-Mansilla, Cristina, Molina, Raquel, San-Juan, Alberto, Barrena-Blázquez, Silvestra, Ortega, Miguel A., Alvarez-Mon, Melchor, Gutiérrez-Calvo, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410473/
https://www.ncbi.nlm.nih.gov/pubmed/36013160
http://dx.doi.org/10.3390/jcm11164922
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author Mendoza-Moreno, Fernando
Diez-Alonso, Manuel
Matías-García, Belén
Ovejero-Merino, Enrique
Gómez-Sanz, Remedios
Blázquez-Martín, Alma
Quiroga-Valcárcel, Ana
Vera-Mansilla, Cristina
Molina, Raquel
San-Juan, Alberto
Barrena-Blázquez, Silvestra
Ortega, Miguel A.
Alvarez-Mon, Melchor
Gutiérrez-Calvo, Alberto
author_facet Mendoza-Moreno, Fernando
Diez-Alonso, Manuel
Matías-García, Belén
Ovejero-Merino, Enrique
Gómez-Sanz, Remedios
Blázquez-Martín, Alma
Quiroga-Valcárcel, Ana
Vera-Mansilla, Cristina
Molina, Raquel
San-Juan, Alberto
Barrena-Blázquez, Silvestra
Ortega, Miguel A.
Alvarez-Mon, Melchor
Gutiérrez-Calvo, Alberto
author_sort Mendoza-Moreno, Fernando
collection PubMed
description Objectives: The aim of this study was to analyze the prognostic factors of survival in patients with peritoneal metastasis (PM) from colorectal cancer (CRC). The type of relationship between survival and the PM time of detection was used to determine whether it was synchronous with the primary tumor or metachronous. Patients and Methods: Retrospective observational study. It included patients treated for colorectal adenocarcinoma diagnosed between January 2005 and December 2019 who presented PM at the time of diagnosis or during follow-up. Variables, such as sex, age, differentiation grade, positive adenopathy (pN+), tumor size (pT), tumor location, mucinous component, peritoneal carcinomatosis index (PCI), and KRAS mutational status, were analyzed. Results: During the study period, 1882 patients were surgically treated for CRC in our hospital. Of these, 240 patients (12.8%) were included in the study after evidence of PM. The mean age was 67 ± 12 years (range: 32–92 years), and 114 patients were female (47.5%). The mean follow-up was 20 ± 13 months (median 12 months). The Kaplan–Meier survival at 36 months was higher in patients with metachronous PM (24% vs. 8%; p = 0.002), WT-KRAS tumors (31% vs. 15%; p < 0.001), N0 stage (30% vs. 19%; p < 0.001), T3 stage tumors (18% vs. 19% in T4A and 3% in T4B; p > 0.001), and tumors with classic adenocarcinoma histology (18% vs. 8%; p = 0.011). Patients with a PCI of 1–10 showed a likelihood of survival at 36 months of 56%, which was longer than that found in patients with a PCI of 11–20 (8%) or a PCI of >20 (0%) (p < 0.001). In the multiple regression analysis, the factors with an independent prognostic value were: poor grade of differentiation (HR 1.995; 95% CI: 1.294–3.077), KRAS mutation (HR 1.751; 95% CI: 1.188–2.581), PCI 11–20 (HR: 9.935; 95% CI: 5.204–18.966) and PCI > 20 (HR: 4.011; 95% CI: 2.291–7.023). Conclusions: PCI should continue as the as the most useful prognostic indicator in order to assess prognostic estimations as well as therapeutic and surgical decisions, but tumor grade and KRAS mutational status may help in the treatment decision process by providing complementary information. The time of PM detection did not achieve statistical significance in the multiple regression analysis.
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spelling pubmed-94104732022-08-26 Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer Mendoza-Moreno, Fernando Diez-Alonso, Manuel Matías-García, Belén Ovejero-Merino, Enrique Gómez-Sanz, Remedios Blázquez-Martín, Alma Quiroga-Valcárcel, Ana Vera-Mansilla, Cristina Molina, Raquel San-Juan, Alberto Barrena-Blázquez, Silvestra Ortega, Miguel A. Alvarez-Mon, Melchor Gutiérrez-Calvo, Alberto J Clin Med Article Objectives: The aim of this study was to analyze the prognostic factors of survival in patients with peritoneal metastasis (PM) from colorectal cancer (CRC). The type of relationship between survival and the PM time of detection was used to determine whether it was synchronous with the primary tumor or metachronous. Patients and Methods: Retrospective observational study. It included patients treated for colorectal adenocarcinoma diagnosed between January 2005 and December 2019 who presented PM at the time of diagnosis or during follow-up. Variables, such as sex, age, differentiation grade, positive adenopathy (pN+), tumor size (pT), tumor location, mucinous component, peritoneal carcinomatosis index (PCI), and KRAS mutational status, were analyzed. Results: During the study period, 1882 patients were surgically treated for CRC in our hospital. Of these, 240 patients (12.8%) were included in the study after evidence of PM. The mean age was 67 ± 12 years (range: 32–92 years), and 114 patients were female (47.5%). The mean follow-up was 20 ± 13 months (median 12 months). The Kaplan–Meier survival at 36 months was higher in patients with metachronous PM (24% vs. 8%; p = 0.002), WT-KRAS tumors (31% vs. 15%; p < 0.001), N0 stage (30% vs. 19%; p < 0.001), T3 stage tumors (18% vs. 19% in T4A and 3% in T4B; p > 0.001), and tumors with classic adenocarcinoma histology (18% vs. 8%; p = 0.011). Patients with a PCI of 1–10 showed a likelihood of survival at 36 months of 56%, which was longer than that found in patients with a PCI of 11–20 (8%) or a PCI of >20 (0%) (p < 0.001). In the multiple regression analysis, the factors with an independent prognostic value were: poor grade of differentiation (HR 1.995; 95% CI: 1.294–3.077), KRAS mutation (HR 1.751; 95% CI: 1.188–2.581), PCI 11–20 (HR: 9.935; 95% CI: 5.204–18.966) and PCI > 20 (HR: 4.011; 95% CI: 2.291–7.023). Conclusions: PCI should continue as the as the most useful prognostic indicator in order to assess prognostic estimations as well as therapeutic and surgical decisions, but tumor grade and KRAS mutational status may help in the treatment decision process by providing complementary information. The time of PM detection did not achieve statistical significance in the multiple regression analysis. MDPI 2022-08-22 /pmc/articles/PMC9410473/ /pubmed/36013160 http://dx.doi.org/10.3390/jcm11164922 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mendoza-Moreno, Fernando
Diez-Alonso, Manuel
Matías-García, Belén
Ovejero-Merino, Enrique
Gómez-Sanz, Remedios
Blázquez-Martín, Alma
Quiroga-Valcárcel, Ana
Vera-Mansilla, Cristina
Molina, Raquel
San-Juan, Alberto
Barrena-Blázquez, Silvestra
Ortega, Miguel A.
Alvarez-Mon, Melchor
Gutiérrez-Calvo, Alberto
Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer
title Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer
title_full Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer
title_fullStr Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer
title_full_unstemmed Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer
title_short Prognostic Factors of Survival in Patients with Peritoneal Metastasis from Colorectal Cancer
title_sort prognostic factors of survival in patients with peritoneal metastasis from colorectal cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410473/
https://www.ncbi.nlm.nih.gov/pubmed/36013160
http://dx.doi.org/10.3390/jcm11164922
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