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Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): A nationwide prospective intervention study

Jekunen Antti; Osterlund Emerik; Ovissi Ali; Lehtomäki Kaisa; Osterlund Pia; Poussa Tuija; Lantto Eila; Soveri Leena-Maija; Muhonen Timo; Heervä Eetu; Salminen Tapio; Ålgars Annika; Isoniemi Helena; Kallio Raija; Lepistö Anna; Halonen Päivi; Aroviita Laura; Räsänen Jari; Ristamäki Raija; Nordin Arno; Lindvall-Andersson Reneé; Murashev Maija; Kellokumpu Ilmo; Uutela Aki; Kononen Juha; Nyandoto Paul; Lamminmäki Annamarja

Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): A nationwide prospective intervention study

Jekunen Antti
Osterlund Emerik
Ovissi Ali
Lehtomäki Kaisa
Osterlund Pia
Poussa Tuija
Lantto Eila
Soveri Leena-Maija
Muhonen Timo
Heervä Eetu
Salminen Tapio
Ålgars Annika
Isoniemi Helena
Kallio Raija
Lepistö Anna
Halonen Päivi
Aroviita Laura
Räsänen Jari
Ristamäki Raija
Nordin Arno
Lindvall-Andersson Reneé
Murashev Maija
Kellokumpu Ilmo
Uutela Aki
Kononen Juha
Nyandoto Paul
Lamminmäki Annamarja
Katso/Avaa
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ELSEVIER
doi:10.1016/j.lanepe.2021.100049
URI
https://www.sciencedirect.com/science/article/pii/S2666776221000260?via%3Dihub
Näytä kaikki kuvailutiedot
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2021093047963
Tiivistelmä

Background: Resection of colorectal cancer (CRC) metastases provides good survival but is probably underused in real-world practice.

Methods: A prospective Finnish nationwide study enrolled treatable metastatic CRC patients. The intervention was the assessment of resectability upfront and twice during first-line therapy by the multidisciplinary team (MDT) at Helsinki tertiary referral centre. The primary outcome was resection rates and survival.

Findings: In 2012-2018, 1086 patients were included. Median follow-up was 58 months. Multiple metastatic sites were present in 500 (46%) patients at baseline and in 820 (76%) during disease trajectory. In MDT assessments, 447 (41%) were classified as resectable, 310 (29%) upfront and 137 (18%) after conversion therapy. Sixhundred and ninety curative intent resections or local ablative therapies (LAT) were performed in 399 patients (89% of 447 resectable). Multiple metastasectomies for multisite or later developing metastases were performed in 148 (37%) patients. Overall, 414 liver, 112 lung, 57 peritoneal, and 107 other metastasectomies were performed. Median OS was 80.4 months in R0/1-resected (HR 0.15; CI95% 0.12-0.19), 39.1 months in R2-resected/LAT (0.39; 0.29-0.53) patients, and 20.8 months in patients treated with "systemic therapy alone" (reference), with 5-year OS rates of 66%, 40%, and 6%, respectively.

Interpretation: Repeated centralized MDT assessment in real-world metastatic CRC patients generates high resectability (41%) and resection rates (37%) with impressive survival, even when multisite metastases are present or develop later. 

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