Clinical colorectal cancer最新文献

{"title":"Role of Neoadjuvant Chemotherapy Before Simultaneous Resection of Colon Cancer and Liver Metastases: A Propensity-Score Matched Analysis.","authors":"Sameh Hany Emile, Zoe Garoufalia, Rachel Gefen, Justin Dourado, Ebram Salama, Steven D Wexner","doi":"10.1016/j.clcc.2025.05.005","DOIUrl":"10.1016/j.clcc.2025.05.005","url":null,"abstract":"<p><strong>Background: </strong>There has been a controversy about the optimal management of colorectal liver metastases (CLM). Both upfront surgery and neoadjuvant chemotherapy are viable options for CLM. The present study aimed to assess the short-term and survival outcomes of neoadjuvant chemotherapy before simultaneous resection of primary colon cancer and liver metastases.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the National Cancer Database (2015-2019) on patients with primary colon cancer and synchronous liver metastases. The main exposure was neoadjuvant chemotherapy before simultaneous resection of colon cancer and hepatic metastases. Propensity-score matching was used to match patients who had upfront surgery without neoadjuvant chemotherapy with patients who received neoadjuvant chemotherapy. The primary outcome was 5-year overall survival (OS). Secondary outcomes included hospital stay, 30-day and 90-day mortality, 30-day unplanned readmission, conversion to open surgery, surgical margins, and disease downstaging.</p><p><strong>Results: </strong>Overall, neoadjuvant chemotherapy was given to 38.3% of 4060 patients. After matching, 1446 patients (53% male) were included; 482 were in the neoadjuvant group and 964 were in the no-neoadjuvant group. Neoadjuvant chemotherapy was associated with a longer restricted mean OS (46.7 vs. 40.6 months, P < .001) and significantly lower rates of 90-day mortality (3% vs. 6.5%, P = .008), 30-day unplanned readmission (4.8% vs. 8.8%, P = .002), positive surgical margins (6.5% vs. 15.1%, P < .001), and administration of adjuvant therapy (47.3% vs. 79.5%, P < .001). The 2 groups were comparable in hospital stay, 30-day mortality, and number of examined lymph nodes.</p><p><strong>Conclusions: </strong>Giving neoadjuvant chemotherapy before simultaneous resection of colon cancer and hepatic metastases was associated with extended mean OS and reduced rates of 90-day mortality, 30-day unplanned readmission, and positive surgical margins.</p>","PeriodicalId":93939,"journal":{"name":"Clinical colorectal cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Alcohol Use and Smoking With Early-Onset Colorectal Cancer-A Systematic Review and Meta-Analysis.","authors":"Janine Wieser, Michael Hoffmeister, Hermann Brenner, Ute Mons","doi":"10.1016/j.clcc.2025.05.002","DOIUrl":"10.1016/j.clcc.2025.05.002","url":null,"abstract":"<p><p>The incidence of early-onset CRC (EOCRC) has lately been increasing. We aimed to synthesize findings on the association of smoking and alcohol consumption with EOCRC in a systematic review and meta-analysis. Following preregistration of the study protocol in PROSPERO (CRD42023424149), we searched PubMed and Web of Science for observational studies on the association of smoking or alcohol consumption with EOCRC. We performed meta-analyses, including several subgroup analyses, to examine the association of alcohol consumption and smoking, respectively, with the risk of EOCRC. Generally, random effects models were calculated, with fixed effect models employed for analyses including only a small number of studies. We included eleven studies for alcohol consumption and twelve for smoking. Alcohol use was found to be a risk factor for EOCRC, with a pooled odds ratio (OR) of 1.39 (95 % confidence interval (CI) 1.14-1.69). A dose-response model revealed a positive association between the amount of ethanol consumed and the risk of EOCRC (OR per 10 g/d ethanol increase 1.02, 95 % CI, 1.01-1.08). Smoking (ever or current combined) was also found to be a significant risk factor for EOCRC (OR 1.39, 95 % CI, 1.20-1.59). Alcohol consumption and smoking are significant risk factors for EOCRC and should be addressed in the context of prevention.</p>","PeriodicalId":93939,"journal":{"name":"Clinical colorectal cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Total Neoadjuvant Treatment on Pathological Response and Survival in Locally Advanced Rectal Cancer: A Single Center Experience.","authors":"Okan Aydın, Ahmet Emin Öztürk, Mert Erciyestepe, Şermin Dinç Sonuşen, Zehra Sucuoğlu İşleyen, Selvi Tabak Dinçer, Emir Çelik, Kayhan Ertürk, Muhammed Mustafa Atcı","doi":"10.1016/j.clcc.2025.05.001","DOIUrl":"10.1016/j.clcc.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>Total neoadjuvant therapy (TNT) has emerged as a promising approach in the treatment of locally advanced rectal cancer (LARC), aiming to improve pathological complete response (pCR) and survival by eradicating micrometastases.</p><p><strong>Purpose: </strong>We aimed to evaluate the effect of TNT, which has been applied to patients with LARC in our clinic since 2019, on pathological response and survival and to present real-life data.</p><p><strong>Methods: </strong>The medical records of 116 patients with stage 3 locally advanced rectal cancer who were followed at our clinic between March 2019 and March 2024 and who received TNT were retrospectively analyzed. Patients with pCR and non-pCR and TRG 0-1 and 2-3 were compared.</p><p><strong>Results: </strong>The median follow-up period was 24.5. All of these 116 patients, were stage 3 (mostly stage 3B). Surgery was performed in 106 patients after TNT and 10 patients (8.6%) were followed with nonoperative management (NOM). Pathological complete response (pCR) was achieved in 28 (26.5%) of these 106 patients. The number of CAP-TRG 1 patients (near-pCR) was 35 (33%) and the number of CAP-TRG 2-3 patients was 43 (40.5%). Complete and near-complete responses (pCR and near-pCR) were achieved in approximately 60% of patients. Two parameters showed statistical significance in the univariate analysis of factors affecting pCR; tumor distance from the anal verge > 10 cm increased pCR 7.2-fold (P = .02) and CEA level at diagnosis ≤ 5 ng/ml increased pCR 4.4-fold (P = .008). During follow-up, 10 patients developed recurrence and/or metastasis and 5 of these 10 patients died. The majority of treatment-related toxicities were manageable grade 1-2 toxicities.</p><p><strong>Conclusion: </strong>These single center, real-world data provide a perspective on the impact of TNT on pathological response and survival in patients with LARC. TNT is an effective and safe treatment and has become the standard of care with increased pathological complete response rates.</p>","PeriodicalId":93939,"journal":{"name":"Clinical colorectal cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Real-World Outcomes of First Line EGFR Inhibitor Use, Cetuximab Versus Panitumumab, in Patients with Left-Sided, RAS Wild-Type, Metastatic Colorectal Cancer.","authors":"Jane McKenzie, Vanessa Wong, Shehara Mendis, Rachel Wong, Suzanne Kosmider, Yat Hang To, Louise Nott, Jeremy Shapiro, Javier Torres, Belinda Lee, Azim Jalali, Stephanie Hui-Su Lim, Susan Caird, Adnan Khattak, Peter Gibbs","doi":"10.1016/j.clcc.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.clcc.2025.04.001","url":null,"abstract":"<p><strong>Background: </strong>Epidermal growth factor receptor inhibitors (EGFRi), most commonly cetuximab and panitumumab, are first-line options for patients with left-sided, RAS wildtype (RASwt) metastatic colorectal cancer. Limited data is available comparing EGFRi outcomes.</p><p><strong>Methods: </strong>Data for patients diagnosed January 2015 to October 2024 was reviewed from TRACC, a prospective, multi-site Australasian colorectal cancer registry. Patients with left-sided, RASwt disease treated with an EGFRi as first-line (1 L) therapy were identified. Survival outcomes were calculated using Kaplan-Meir methods.</p><p><strong>Results: </strong>We identified 747 patients with RASwt, left-sided, metastatic colorectal cancer. Of these, 287 (38%) received 1 L therapy that included cetuximab (n = 210, 73%) or panitumumab (n = 77, 27%). A switch from one to the other agent occurred in seven patients, all due to skin toxicity, including six patients (7.8%) initially treated with panitumumab and 1 (0.5%) initially treated with cetuximab. After switching, median time on the second EGFRi agent was 212 days. For 242 patients treated with an EGFRi in combination with doublet chemotherapy, toxicity contributed to treatment cessation more often in patients treated with panitumumab (32% vs. 13%, P = .003). For the subset of patients treated with palliative intent (n = 156), median progression-free (P = .43) and overall survival (P = .98) were similar for both EGFRi.</p><p><strong>Conclusion: </strong>In this real-world analysis, a switch from one EGFRi agent to the other in the presence of skin toxicity led to durable treatment benefit with the alternate EGFRi. For patients receiving first-line cetuximab or panitumumab in combination with doublet chemotherapy, toxicity-related treatment cessation rates differed between EGFRi agents. No differences were seen in survival outcomes.</p>","PeriodicalId":93939,"journal":{"name":"Clinical colorectal cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Sub-Clonal RAS/BRAF Alterations in Liquid Biopsies From Patients With Advanced or Metastatic CRC.","authors":"Peter Gibbs, Khalid Abubaker, Danyi Wang, Zheng Feng, Jawad Hamad, Jiemin Liao, Christopher Stroh, Soetkin Vlassak, Kathrin Heinrich, Adnan Khattak, Juergen Scheuenpflug","doi":"10.1016/j.clcc.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.clcc.2025.03.004","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC), a global health concern, requires effective treatments. Anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibodies are used for RAS wild-type and BRAF^V600 mutation-negative metastatic CRC (mCRC) but are not indicated for RAS mutant CRC. Evidence suggests CRC patients with sub-clonal RAS/BRAF mutations in tumor tissue may benefit from anti-EGFRs. We assessed the outcomes of patients with sub-clonal RAS/BRAF mutated advanced/mCRC receiving anti-EGFRs using liquid-based GuardantINFORM real-world clinical-genomic analysis.</p><p><strong>Patients and methods: </strong>GuardantINFORM analyzed US patients with advanced CRC with BRAF^V600/KRAS/NRAS mutations who received anti-EGFR therapies within 90 days after a Guardant360 test. Primary endpoints were time-to-next treatment (TTNT) and overall survival (OS) (compared across RAS/BRAF mutation clonality cut-offs of 0.3-0.8 using the Cox proportional hazards model).</p><p><strong>Results: </strong>In GuardantINFORM, 446 patients initiated anti-EGFR therapy within 90 days after the Guardant360 test, and 11%, 9%, and 1% had BRAF^V600E, KRAS, or NRAS mutations, respectively; median distribution of RAS/BRAF clonality was 0.84 (IQR, 0.57-1.00). The data show that patients harboring sub-clonal RAS/BRAF mutations benefited from anti-EGFR therapy to a degree similar to patients without RAS/BRAF mutations. For cut-offs of 0.3 to 0.8, sub-clonal RAS/BRAF had similar TTNT to patients without RAS/BRAF mutations, while clonal RAS/BRAF had a significantly shorter TTNT. For cut-offs of 0.3 to 0.7, sub-clonal RAS/BRAF had similar OS to RAS/BRAF mutations not detected, while clonal RAS/BRAF had a significantly shorter OS.</p><p><strong>Conclusion: </strong>Consistent with tumor tissue biopsy data, patients with CRC harboring sub-clonal RAS/BRAF mutations as assessed by liquid biopsy may derive benefit from anti-EGFR therapy, warranting further investigation.</p>","PeriodicalId":93939,"journal":{"name":"Clinical colorectal cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Oligometastatic BRAFV600E Mutant Colorectal Cancer: Learning From a Clinical Case.","authors":"Renato Maria Marsicano, Luca Boscolo Bielo, Elena Guerini Rocco, Mariano Lombardi, Emilio Bertani, Filippo Maria Bassi, Giuseppe Curigliano, Davide Ciardiello, Nicola Fazio, Maria Giulia Zampino","doi":"10.1016/j.clcc.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.clcc.2025.03.003","url":null,"abstract":"","PeriodicalId":93939,"journal":{"name":"Clinical colorectal cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Relevance of ctDNA RAS Mutation in Patients With Metastatic Colorectal Cancer Treated With Cetuximab.","authors":"Seong-Eun Kim, Ji Sung Lee, Sun Young Kim, Jeong Eun Kim, Yong Sang Hong, Tae Won Kim","doi":"10.1016/j.clcc.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.clcc.2025.03.002","url":null,"abstract":"<p><strong>Background: </strong>RAS mutations are important biomarkers for predicting the efficacy of anti-EGFR treatment in metastatic colorectal cancer (mCRC). The emergence of RAS mutations is a known resistance mechanism. This study aimed to evaluate the prognostic significance of circulating tumor DNA (ctDNA) RAS mutations in patients with mCRC treated with cetuximab, focusing on the temporal dynamics of RAS mutation emergence.</p><p><strong>Patients and methods: </strong>Patients with tissue-confirmed RAS wild-type mCRC were included in the study. ctDNA samples were collected at baseline, every 8 weeks during treatment, and after the final cetuximab dose. Cetuximab, combined with FOLFOX or FOLFIRI, was administered as first-line therapy. The primary objective was to assess the impact of emergent ctDNA RAS mutations on progression-free survival (PFS) during cetuximab-based treatment in the first-line setting.</p><p><strong>Results: </strong>A total of 49 patients contributed at least 1 ctDNA sample, with 320 samples collected in total. The baseline concordance rate between ctDNA and tissue RAS status was 89.1% (41/46). Among 41 baseline RAS wild-type cases, 22 (53.7%) demonstrated emergent RAS mutations. The median time to RAS emergence was 12.8 months, and the median PFS was 12.7 months. Temporal analysis revealed that a single detection of RAS mutation was not consistently associated with poor PFS and could resolve in subsequent tests. However, time-dependent analysis indicated that the presence of ctDNA RAS mutations at any time point was significantly associated with poorer PFS (adjusted HR = 2.24, P = .02).</p><p><strong>Conclusion: </strong>The emergence of ctDNA RAS mutations during cetuximab-based first-line therapy exhibits temporal variability. Nevertheless, the presence of ctDNA RAS mutations at any time point is collectively associated with reduced PFS.</p>","PeriodicalId":93939,"journal":{"name":"Clinical colorectal cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}