SAN DIEGO (EGMN) – Most colorectal cancer patients who present with hepatic-only metastatic disease will develop extrahepatic tumor progression within 1 year, results from a single-center study showed.

The finding suggests that integration of in situ local therapies early in the course of disease may favorably improve time to tumor progression of extrahepatic metastases, Dr. Pritesh Mutha said at the annual meeting of the Society of Interventional Radiology.

To better understand the natural history of extrahepatic disease progression in hepatic-only metastatic colorectal cancer (mCRC), Dr. Mutha and his colleagues reviewed the electronic medical records of 44 patients with the U.S. National Cancer Institute’s Surveillance Epidemiology and End Results summary stage VII hepatic-only mCRC registry at the M.D. Anderson Cancer Center, Houston, from 1997 to 2006. Data collected included dates of diagnosis/presentation, metastases frequency and sites, and results of imaging studies. The median follow-up was 24 months.

Dr. Mutha, of the cancer center’s interventional radiology section, reported that 31 of the 44 patients (71%) had extrahepatic progression of their disease, while 13 (29%) did not. Of the 31 patients with extrahepatic progression, 15 had received prior chemotherapy and 16 had not.

The time to tumor progression among patients who received chemotherapy was a mean of 13 months, with a range of 1-22 months, while the mean time to tumor progression among patients who had not received chemotherapy was 1.5 months, with a range of 1-6 months.

Dr. Mutha said that 67% of patients who received prior chemotherapy progressed hepatically before progressing extrahepatically, which indicates that if local chemotherapy were used early, it might improve the time to tumor progression in patients.

The main locations of extrahepatic metastases were lymphatic (29) and pulmonary (14), followed by peritoneal (4), osseous (2), and other (1).

Dr. Mutha acknowledged certain limitations of the study, including the fact that M.D. Anderson is a quaternary care center, whereas most colorectal cancer patients present for first-line treatment in the community setting, “so our small cohort might show a skewed representation of metastatic colorectal cancer,” he said.

He estimated that there are 25,000-30,000 yearly cases of hepatic mCRC in the United States, about 70% of which are unresectable.

Dr. Mutha had no conflicts to disclose.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

圣迭哥 (EGMN)——一个单中心的研究表明，大多数有肝转移的大肠癌患者一年内均会出现肝外转移。

Pritesh Mutha医生在介入放射学年会上指出，研究表明早期原位局部介入治疗可能推迟肝外转移的时间。

为了更好地了解仅有肝转移的大肠癌(mCRC)的肝外转移的自然病程，Mutha医生和他的同事们回顾了在休斯敦M.D. Anderson癌症中心登记的44例仅有肝转移的大肠癌病人电子病历(1997年至2006年)，资料来源于美国国立癌症研究所的流行病学监测和结果阶段性总结VII。收集的数据包括诊断和表现、转移的频率和部位，以及影像学结果。中位随访期为24个月。

Mutha医生，该癌症中心的介入放射科医生，报告44例中的31例(71%)有肝外进展，13例 (29%)无肝外转移。有肝外转移的31例中有15例以往接受了化疗，16例未接受过化疗。

接受化疗患者的肿瘤进展时间平均为13个月(1~22个月)，而未接受化疗的患者肿瘤进展的时间平均为1.5个月(1~ 6个月)。

Mutha医生说，接受化疗患者中，有67%的病例先发生肝内进展，而后出现肝外转移，提示如果早期应用局部化疗，可能推迟肿瘤进展。

肝外转移的主要部位包括淋巴结(29)和肺(14) ，其次是腹膜(4)、骨(2)及其他部位(1) 。

Mutha医生承认该研究具有局限性，包括M.D. Anderson是一个四级医疗中心，大多数大肠癌患者在社区医院接受一线治疗。他指出“该研究中的小队列可能无法代表转移性大肠癌。”

他估计在美国每年有25,000~30,000例肝转移性结肠癌，大约70%是无法切除的。

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