Dados do Trabalho

Título

IMPACT OF CLINICAL, PATHOLOGICAL, AND MOLECULAR FACTORS IN COLORECTAL CANCER PATIENTS UNDERGOING METASTASECTOMY WITH CURATIVE INTENT.

Introdução

Until now, metastasis resection is considered the only potentially curative strategy for metastatic colorectal cancer (mCRC).Despite the great advances in the management of these patients, especially in chemotherapy regimens, the better understanding of the genetic signature of tumors and the improvement of surgical techniques, more recent data have not been able to demonstrate adequate prognostic stratification of classic clinical scores, without a complete analysis,which accurately integrates all ​​significant variables in the management of this subset of patients, primarily as a therapeutic decision tool in referring patients for metastasectomy with curative intent (MCI).

Objetivo

This study aims to demonstrate the median overall survival of patients with mCRC undergoing MCI, describing and correlating the clinical, anatomical,pathological and molecular variables that are associated with the evolution of these patients.

Método

This is a retrospective cohort, with data analysis of patients with stage IV colorectal cancer, at a referral cancer care institution.Survival curves were obtained by the Kaplan and Meier method.The differences between the survival curves were tested by the logrank test.Cox's semi-parametric model were adjusted to calculate the Hazard Ratio (HR).In all tests,a significance level of 5% was assumed.

Resultado

121 patients were evaluated. Liver resection was the most performed surgery (49.5%), followed by lungs (19%) and peritoneum (9.09%). The median OS was 116 months (95% CI 45.9 months; NA). The ​​independent prognostic variables, statistically significant for OS in the multivariate analysis, were: age <70 years (HR=0.48 CI 0.21-0.88; p=0.049), less advanced lymph node staging (pN0 or pN1) (HR=0.47;CI 0.14-0.99 p=0.046),mutation in the KRAS or NRAS (HR=3.53 CI 1.37-9.15 p=0.009) and the location of the primary tumor (LPT), with patients with primary cancer in the right colon being 1.78 times more likely to die than patients with primary tumors in the left colon after metastasectomies (CI 1.40;3.98 p =0.043).

Conclusão

The median OS of this cohort was 116 months.The variables associated with the improvement in OS were: LPT in the left colon, absence of RAS gene mutation, age <70 years and less advanced stages of the primary tumor.All these variables, analyzed together, can be used to guide the individualized treatment of colorectal cancer and contribute to a more adequate selection of patients who are candidates for surgical resection of metastases with curative intent.

Palavras-chave

Colorectal Neoplasms, Metastasectomy, survival, prognostic factors.