Impact of recommendations and new therapies on the prognosis of colon cancer with synchronous liver metastasis.

OBJECTIVE

To assess the prognostic impact of the new therapies recommended over the past twenty years for colonic cancers with synchronous hepatic metastasis (hmCC).

METHODS

From 1995 to 2016, 802 hmCC were identified in a tumor registry. An univariate and multivariate analysis looked for the impact of the different recommendations over three periods: chemotherapy without targeted therapy (p1CH), chemotherapy with targeted agent in 2nd line (p2TA2), chemotherapy with TA in 1st line (p3TA1) depending on anatomoclinical criteria and therapeutic sequences: chemotherapy then resection of the primary tumor (CR) (n = 100), resection of the primary tumor then chemotherapy (RC) (n = 541), chemotherapy alone with or without TC (onlyCH) (n = 161).

RESULTS

The rates of onlyCH, CR and RC had varied respectively during these 3 periods from 12% to 26%, 6% to 21% and from 82% to 53% (p = 0.001). The medians of p1CH, p2TA2 and p3TA1 survival were 20.2, 22.7 and 23.6 months, respectively (p = 0.12). The independent factors of poor prognosis were age ≥ 75 years (1.6 [1.35; 1.9] p = 0.0001), chemotherapy only 2.3 [1.6; 3.5] p = 0.0001), p1CH 1.7 [1.4; 2.1] p<0.0001), p2TA2 1.2 [1.02;1.6] p = 0.04. The p2TA2 period had a worse prognosis than p3TA1 (1.25 [1.01; 1.5] p = 0.03).

CONCLUSION

In public health point of view, the recommendation of first-line TA improved survival and increased rate of primary tumor resection after chemotherapy.