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

Abstract

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.