Risk of metachronous peritoneal metastases in patients with pT4a versus pT4b colon cancer: An international multicentre cohort study. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Bastiaenen, Vivian P.; Aalbers, Arend G.J.; Arjona-Sánchez, Alvaro; Bellato, Vittoria; van der Bilt, Jarmila D.W.; D'Hoore, André D.; Espinosa-Redondo, Esther; Klaver, Charlotte E.L.; Nagtegaal, Iris D.; van Ramshorst, Bert; van Santvoort, Hjalmar C.; Sica, Giuseppe S.; Snaebjornsson, Petur; Wasmann, Karin A.T.G.M.; de Wilt, Johannes H.W.; Wolthuis, Albert M.; Tanis, Pieter J.
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 9(2021)
• Page Start: 2405
• Page End: 2413
• Publication Date: 2021-09
• Subjects: Locally advanced colon cancer -- T4 colon cancer -- Peritoneal metastases -- Oncological outcomes -- Survival; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.05.009
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: With evolving treatment strategies aiming at prevention or early detection of metachronous peritoneal metastases (PM), identification of high-risk colon cancer patients becomes increasingly important. This study aimed to evaluate differences between pT4a (peritoneal penetration) and pT4b (invasion of other organs/structures) subcategories regarding risk of PM and other oncological outcomes. Materials and methods: From eight databases deriving from four countries, patients who underwent curative intent treatment for pT4N0-2M0 primary colon cancer were included. Primary outcome was the 5-year metachronous PM rate assessed by Kaplan-Meier analysis. Independent predictors for metachronous PM were identified by Cox regression analysis. Secondary endpoints included 5-year local and distant recurrence rates, and 5-year disease free and overall survival (DFS, OS). Results: In total, 665 patients with pT4a and 187 patients with pT4b colon cancer were included. Median follow-up was 38 months (IQR 23–60). Five-year PM rate was 24.7% and 12.2% for pT4a and pT4b categories, respectively (p = 0.005). Independent predictors for metachronous PM were female sex, right-sided colon cancer, peritumoral abscess, pT4a, pN2, R1 resection, signet ring cell histology and postoperative surgical site infections. Five-year local recurrence rate was 14% in both pT4a and pT4b cancer (p = 0.138). Corresponding five-year distant metastases rates were 35% and 28% (p = 0.138). Five-year DFS and OS were 54% vs. 62% (p = 0.095) and 63% vs. 68% (p = 0.148) for pT4a vs. pT4b categories, respectively. Conclusion: Patients with pT4a colon cancer have a higher risk of metachronous PM than pT4b patients. This observation has important implications for early detection and future adjuvant treatment strategies.