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Title: Risk of metachronous peritoneal metastases in patients with pT4a versus pT4b colon cancer: An international multicentre cohort study.
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
Keywords: Locally advanced colon cancer;Oncological outcomes;Peritoneal metastases;Survival;T4 colon cancer
metadata.dc.subject.mesh: Abdominal Abscess
Carcinoma, Signet Ring Cell
Chemotherapy, Adjuvant
Cohort Studies
Colon, Ascending
Colon, Transverse
Colonic Neoplasms
Disease-Free Survival
Middle Aged
Neoadjuvant Therapy
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Peritoneal Neoplasms
Risk Factors
Sex Factors
Surgical Wound Infection
Survival Rate
Issue Date: 15-May-2021
Abstract: 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. 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). 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. 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.
metadata.dc.identifier.doi: 10.1016/j.ejso.2021.05.009
Appears in Collections:Producción 2020

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